We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Long-term outcome of a third anti- TNF monoclonal antibody after the failure of two prior anti- TNFs in inflammatory bowel disease.
- Authors
Silva, P. S. A.; Nguyen, D. D.; Sauk, J.; Korzenik, J.; Yajnik, V.; Ananthakrishnan, A. N.
- Abstract
Background A significant proportion of patients with IBD lose response to anti- TNF therapies. There is limited knowledge of the long-term outcomes of those who have failed two anti- TNF agents and commenced a third. Aim To examine the safety and efficacy of third anti-TNF treatment after failure of two prior anti-TNF agents in patients with inflammatory bowel disease. Methods This was a retrospective study of all IBD patients [ Crohn's disease ( CD), ulcerative colitis ( UC)] treated with a third anti- TNF agent after loss of response or intolerance to two prior anti- TNF agents at a single tertiary North American centre. Disease activity, drug therapy and Montreal phenotypes were noted at disease onset and commencement of the third anti- TNF agent. Kaplan- Meier estimates were used to calculate the probability of remaining on the third anti- TNF agent and to identify predictors of long-term clinical response. Results A total of 63 patients (64% women, 57 CD and 6 UC) were included in the analysis. The mean disease duration at initiation of third anti- TNF was 12 years. Thirty-five (55.6%) patients discontinued the third anti- TNF after a mean of 13.2 months. Probability of remaining on the third anti- TNF was 0.69, 0.55, 0.37 and 0.25 at 6, 12, 24 and 36 months respectively. Prior primary nonresponders to the first anti- TNF agent [hazard ratio ( HR) 6.4, 95% CI 2.5-16.1] and persistent disease activity at 3 months after commencement of a third anti- TNF ( HR 3.2, 95% CI 1.3-7.8) predicted poorer response. Conclusions Over half of patients with inflammatory bowel disease, initiated on a third anti- TNF agent after failure of two prior anti- TNF drugs, are able to remain on the third anti- TNF at 1 year.
- Subjects
NORTH America; MONOCLONAL antibodies; INFLAMMATORY bowel disease treatment; TUMOR necrosis factors; RETROSPECTIVE studies; COLITIS treatment; ULCERATIVE colitis; DRUG therapy; PHENOTYPES
- Publication
Alimentary Pharmacology & Therapeutics, 2012, Vol 36, Issue 5, p459
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/j.1365-2036.2012.05214.x