Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

María José Casanova, María Chaparro, Miguel Mínguez, Elena Ricart, Carlos Taxonera, Santiago García-López, Jordi Guardiola, Antonio López-San Román, Eva Iglesias, Belén Beltrán, Beatriz Sicilia, María Isabel Vera, Joaquín Hinojosa, Sabino Riestra, Eugeni Domènech, Xavier Calvet, José Lázaro Pérez-Calle, María Dolores Martín-Arranz, Xavier Aldeguer, Montserrat Rivero, David Monfort, Jesús Barrio, María Esteve, Lucía Márquez, Rufo Lorente, Esther García-Planella, Luisa de Castro, Fernando Bermejo, Olga Merino, Antonio Rodríguez-Pérez, Pilar Martínez-Montiel, Manuel Van Domselaar, Guillermo Alcaín, Manuel Domínguez-Cajal, Carmen Muñoz, Fernando Gomollón, Luis Fernández-Salazar, Mariana Fe García-Sepulcre, Iago Rodríguez-Lago, Ana Gutiérrez, Federico Argüelles-Arias, Cristina Rodriguez, Gloria Esther Rodríguez, Luis Bujanda, Jordina Llaó, Pilar Varela, Laura Ramos, José María Huguet, Pedro Almela, Patricia Romero, Mercè Navarro-Llavat, Águeda Abad, Patricia Ramírez-de la Piscina, Alfredo J Lucendo, Eva Sesé, Rosa Eva Madrigal, Mara Charro, Antonio García-Herola, Ramón Pajares, Sam Khorrami, Javier P Gisbert
Inflammatory Bowel Diseases 2019 August 29

BACKGROUND: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients.

METHODS: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent.

RESULTS: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug.

CONCLUSIONS: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response.

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