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Long‐term outcome of a third anti‐ TNF monoclonal antibody after the failure of two prior anti‐ TNF s in inflammatory bowel disease
Author(s) -
Silva P. S. A.,
Nguyen D. D.,
Sauk J.,
Korzenik J.,
Yajnik V.,
Ananthakrishnan A. N.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05214.x
Subject(s) - medicine , ulcerative colitis , inflammatory bowel disease , tumor necrosis factor alpha , hazard ratio , gastroenterology , disease , infliximab , colitis , tnf inhibitor , immunology , confidence interval
Summary 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 [ C rohn'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 N orth A merican centre. Disease activity, drug therapy and M ontreal phenotypes were noted at disease onset and commencement of the third anti‐ TNF agent. K aplan– M eier 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.