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

Author:

Casanova María José1ORCID,Chaparro María1,Mínguez Miguel2,Ricart Elena3,Taxonera Carlos4,García-López Santiago5,Guardiola Jordi6,López-San Román Antonio7,Iglesias Eva8,Beltrán Belén9,Sicilia Beatriz10,Vera María Isabel11,Hinojosa Joaquín12,Riestra Sabino13,Domènech Eugeni14,Calvet Xavier15,Pérez-Calle José Lázaro16,Martín-Arranz María Dolores17,Aldeguer Xavier18,Rivero Montserrat19,Monfort David20,Barrio Jesús21,Esteve María22,Márquez Lucía23,Lorente Rufo24,García-Planella Esther25,de Castro Luisa26,Bermejo Fernando27,Merino Olga28,Rodríguez-Pérez Antonio29,Martínez-Montiel Pilar30,Van Domselaar Manuel31,Alcaín Guillermo32,Domínguez-Cajal Manuel33,Muñoz Carmen34,Gomollón Fernando35,Fernández-Salazar Luis36,García-Sepulcre Mariana Fe37,Rodríguez-Lago Iago38,Gutiérrez Ana39,Argüelles-Arias Federico40,Rodriguez Cristina41,Rodríguez Gloria Esther42,Bujanda Luis43,Llaó Jordina44,Varela Pilar45,Ramos Laura46,Huguet José María47,Almela Pedro48,Romero Patricia49,Navarro-Llavat Mercè50,Abad Águeda51,Ramírez-de la Piscina Patricia52,Lucendo Alfredo J53,Sesé Eva54,Madrigal Rosa Eva55,Charro Mara56,García-Herola Antonio57,Pajares Ramón58,Khorrami Sam59,Gisbert Javier P1

Affiliation:

1. Gastroenterology Department at Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

2. Gastroenterology Department at Hospital Clínico Valencia, Valencia, Spain

3. Gastroenterology Department at Hospital Clínic i Provincial, CIBEREHD and IDIBAPS, Barcelona, Spain

4. Gastroenterology Department at Hospital Universitario Clínico San Carlos, Madrid, Spain

5. Gastroenterology Department at Hospital Universitario Miguel Servet, Barcelona, Spain; and CIBEREHD, Zaragoza, Spain

6. Gastroenterology Department at Hospital Universitario de Bellvitge, Barcelona, Spain

7. Gastroenterology Department at Hospital Universitario Ramón y Cajal, Madrid, Spain

8. Gastroenterology Department at Hospital Universitario Reina Sofía, Córdoba, Spain

9. Gastroenterology Department at Hospital Universitario La Fe, and CIBEREHD, Valencia, Spain

10. Gastroenterology Department at Hospital Universitario de Burgos, Burgos, Spain

11. Gastroenterology Department at Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

12. Gastroenterology Department at Hospital de Manises, Valencia, Spain

13. Gastroenterology Department at Hospital Universitario Central de Asturias, Oviedo, Spain

14. Gastroenterology Department at Hospital Universitario Germans Trias i Pujol, and CIBEREHD, Badalona, Spain

15. Gastroenterology Department at Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, and CIBEREHD, Sabadell, Spain

16. Gastroenterology Department at Hospital Universitario Fundación de Alcorcón, Madrid, Spain

17. Gastroenterology Department at Hospital Universitario La Paz,, Girona, Spain; Instituto de Investigación de La Paz (IdiPaz), Madrid, Spain

18. Gastroenterology Department at Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain

19. Gastroenterology Department at Hospital Universitario Marqués de Valdecilla,, Terrassa, Spain; IDIVAL, Santander, Spain

20. Gastroenterology Department at Consorci Sanitari Terrassa, Terrassa, Spain

21. Gastroenterology Department at Hospital Universitario Río Hortega, Valladolid, Spain

22. Gastroenterology Department at Hospital Universitario Mútua Terrassa, and CIBEREHD, Terrassa, Spain

23. Gastroenterology Department at Hospital del Mar, Barcelona, Spain

24. Gastroenterology Department at Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

25. Gastroenterology Department at Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

26. Gastroenterology Department at Complejo Hospitalario Universitario de Vigo, Vigo, Spain

27. Gastroenterology Department at Hospital Universitario de Fuenlabrada and Instituto de Investigación de La Paz (IdiPaz), Madrid, Spain

28. Gastroenterology Department at Hospital Universitario Cruces, Barakaldo, Spain

29. Gastroenterology Department at Hospital Clínico Universitario de Salamanca, Salamanca

30. Gastroenterology Department at Hospital Universitario Doce de Octubre, Madrid, Spain

31. Gastroenterology Department at Hospital de Torrejón, Madrid

32. Gastroenterology Department at Hospital Universitario Virgen de la Victoria, Málaga, Spain

33. Gastroenterology Department at Hospital General San Jorge, Huesca, Spain

34. Gastroenterology Department at Hospital de Basurto, Bilbao, Spain

35. Gastroenterology Department at Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

36. Gastroenterology Department at Hospital Clínico Universitario de Valladolid, Valladolid, Spain

37. Gastroenterology Department at Hospital General Universitario de Elche, Alicante, Spain

38. Gastroenterology Department at Hospital de Galdakao-Usansolo, Galdakao, Spain

39. Gastroenterology Department at Hospital General Universitario de Alicante, and CIBEREHD, Alicante, Spain

40. Gastroenterology Department at Hospital Universitario Virgen Macarena, Sevilla, Spain

41. Gastroenterology Department at Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

42. Gastroenterology Department at Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain

43. Gastroenterology Department at Hospital Universitario de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Donostia, Spain

44. Gastroenterology Department at ALTHAIA Xarxa Assistencial Universitària de Manresa, Manresa, Spain

45. Gastroenterology Department at Hospital Universitario de Cabueñes, Gijón, Spain

46. Gastroenterology Department at Hospital Universitario de Canarias, La Laguna, Spain

47. Gastroenterology Department at Consorcio Hospital General Universitario de Valencia, Valencia, Spain

48. Gastroenterology Department at Hospital General Universitario de Castellón, Castellón, Spain

49. Gastroenterology Department at Hospital General Universitario de Santa Lucía, Murcia, Spain

50. Gastroenterology Department at Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain

51. Gastroenterology Department at Hospital de Viladecans, Barcelona, Spain

52. Gastroenterology Department at Hospital Universitario de Álava, Vitoria, Spain

53. Gastroenterology Department at Hospital General de Tomelloso, Ciudad Real, Spain

54. Gastroenterology Department at Hospital Universitario Arnau de Vilanova, Lleida, Spain

55. Gastroenterology Department at Complejo Asistencial Universitario de Palencia, Palencia, Spain

56. Gastroenterology Department at Hospital Royo Villanova, Zaragoza, Spain

57. Gastroenterology Department at Hospital Marina Baixa, Alicante, Spain

58. Gastroenterology Department at Hospital Universitario Infanta Sofía, Madrid, Spain

59. Gastroenterology Department at Hospital Universitario Son Espases, Palma de Mallorca, Spain

Abstract

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.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,Immunology and Allergy

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