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JOURNAL ARTICLE
MULTICENTER STUDY

Effectiveness of anti-TNFα drugs in patients with Crohn's disease who do not achieve remission with their first anti-TNFα agent

María Del Carmen R-Grau, María Chaparro, Francisco Mesonero, Manuel Barreiro-de Acosta, Luisa Castro, Manuel Castro, Eugeni Domènech, Noemí Mancenido, José Lázaro Pérez-Calle, Carlos Taxonera, Jesús Barrio, Ruth De Francisco, Estela Fernández-Salgado, Lara Luzón, Olga Merino, Lorena Oltra, Cristina Saro, Fernando Bermejo, Valle García-Sánchez, Daniel Ginard, Ana Gutiérrez, Isabel Vera, Rosario Antón, Yolanda Ber, Xavier Calvet, Javier P Gisbert
Digestive and Liver Disease 2016, 48 (6): 613-9
26992847

BACKGROUND: Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs.

AIMS: To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability.

METHODS: Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy.

RESULTS: In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR=0.3, 95% CI=0.1-0.7, P=0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively.

CONCLUSIONS: Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.

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