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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

2019; Oxford University Press; Linguagem: Inglês

10.1093/ibd/izz192

1536-4844

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-Muñoz, 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, R Lorente, Esther García-Planella, Luisa de Castro, Fernando Bermejo, Olga Merino, Antonio Rodríguez-Pérez, Pilar Martínez-Montiel, Manuel Van Domselaar, G Alcaín, Manuel Domínguez‐Cajal, Carmen Muñoz, Fernando Gomollón, Luís Fernández-Salazar, Mariana Fe García-Sepulcre, Iago Rodríguez‐Lago, Ana Gutiérrez, Federico Argüelles‐Arias, Cristina Rodríguez, G E Rodríguez, Luís 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,

Autoimmune and Inflammatory Disorders

Abstract 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.