Laurent Peyrin-Biroulet1, Julia Salleron2, Jérôme Filippi3, Catherine Reenaers4, Ophélie Antunes3, Virginie Filipe5, Edouard Louis4, Xavier Hébuterne3, Xavier Roblin6. 1. Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France peyrinbiroulet@gmail.com. 2. Department of Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France. 3. Institute for Research on Cancer and Aging, Department of Gastroenterology & Nutrition, Hôpital de l'Archet, Nice, France. 4. Gastroenterology Department, University of Liège, Liège, Belgium. 5. Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France. 6. Gastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.
Abstract
BACKGROUND: Anti-tumour necrosis factor [TNF] therapy in combination with thiopurine is the most effective strategy for Crohn's disease, but raises safety concerns. METHODS: In a retrospective multicentre study, we investigated long-term outcome of patients starting anti-TNF monotherapy for Crohn's disease and investigated whether introducing an immunomodulator in patients losing response to anti-TNF monotherapy is effective for resetting immunogenicity. RESULTS: A total of 350 adult patients with Crohn's disease received either infliximab [n = 178, 51%] or adalimumab [n = 172, 49%] monotherapy. Mean duration of follow-up was 42 months. An immunomodulator was initiated in 53 patients [15%]. At last follow-up, 73.1% [n = 38] were in clinical remission [one patient with missing data]. Multivariate analysis identified anti-TNF type [higher need for starting immunomodulator for infliximab than for adalimumab; p = 0.0058] and first- vs second-/third-/fourth-line anti-TNF therapy [p = 0.014] as predictors of immunomodulator initiation. Among the 18 patients with available data, introduction of an immunomodulator was able to restore infliximab trough level within the therapeutic range and to induce clinical remission in 10 patients [55%]. Cumulative probability of remaining on anti-TNF therapy was 57.9% at 5 years among the 297 patients not starting an immunomodulator during follow-up. CONCLUSION: An immunomodulator was initiated in 15% of patients with Crohn's disease starting anti-TNF monotherapy. Independent predictors of immunomodulator initiation were infliximab use and second-/third-/fourth-line anti-TNF therapy. Resetting immunogenicity with an immunomodulator was effective in half of patients in a sub-study. Persistence of anti-TNF treatment at 5 years was observed in half of the 297 patients not starting an immumodulator in a real-life setting.
BACKGROUND:Anti-tumour necrosis factor [TNF] therapy in combination with thiopurine is the most effective strategy for Crohn's disease, but raises safety concerns. METHODS: In a retrospective multicentre study, we investigated long-term outcome of patients starting anti-TNF monotherapy for Crohn's disease and investigated whether introducing an immunomodulator in patients losing response to anti-TNF monotherapy is effective for resetting immunogenicity. RESULTS: A total of 350 adult patients with Crohn's disease received either infliximab [n = 178, 51%] or adalimumab [n = 172, 49%] monotherapy. Mean duration of follow-up was 42 months. An immunomodulator was initiated in 53 patients [15%]. At last follow-up, 73.1% [n = 38] were in clinical remission [one patient with missing data]. Multivariate analysis identified anti-TNF type [higher need for starting immunomodulator for infliximab than for adalimumab; p = 0.0058] and first- vs second-/third-/fourth-line anti-TNF therapy [p = 0.014] as predictors of immunomodulator initiation. Among the 18 patients with available data, introduction of an immunomodulator was able to restore infliximab trough level within the therapeutic range and to induce clinical remission in 10 patients [55%]. Cumulative probability of remaining on anti-TNF therapy was 57.9% at 5 years among the 297 patients not starting an immunomodulator during follow-up. CONCLUSION: An immunomodulator was initiated in 15% of patients with Crohn's disease starting anti-TNF monotherapy. Independent predictors of immunomodulator initiation were infliximab use and second-/third-/fourth-line anti-TNF therapy. Resetting immunogenicity with an immunomodulator was effective in half of patients in a sub-study. Persistence of anti-TNF treatment at 5 years was observed in half of the 297 patients not starting an immumodulator in a real-life setting.
Authors: Uri Kopylov; Talal Al-Taweel; Mohammad Yaghoobi; Benedicte Nauche; Alain Bitton; Peter L Lakatos; Shomron Ben-Horin; Waqqas Afif; Ernest G Seidman Journal: J Crohns Colitis Date: 2014-07-25 Impact factor: 9.071
Authors: Jean Frédéric Colombel; William J Sandborn; Walter Reinisch; Gerassimos J Mantzaris; Asher Kornbluth; Daniel Rachmilewitz; Simon Lichtiger; Geert D'Haens; Robert H Diamond; Delma L Broussard; Kezhen L Tang; C Janneke van der Woude; Paul Rutgeerts Journal: N Engl J Med Date: 2010-04-15 Impact factor: 91.245
Authors: Laurent Peyrin-Biroulet; Edward V Loftus; Jean-Frederic Colombel; William J Sandborn Journal: Am J Gastroenterol Date: 2009-10-27 Impact factor: 10.864
Authors: Diana M Negoescu; Eva A Enns; Brooke Swanhorst; Bonnie Baumgartner; James P Campbell; Mark T Osterman; Konstantinos Papamichael; Adam S Cheifetz; Byron P Vaughn Journal: Inflamm Bowel Dis Date: 2020-01-01 Impact factor: 5.325
Authors: Philip A Baer; Guy Aumais; Emmanuel M Ewara; Majed Khraishi; A Marilise Marrache; Remo Panaccione; John P Wade; John K Marshall Journal: Patient Prefer Adherence Date: 2018-09-18 Impact factor: 2.711
Authors: Fotios S Fousekis; Konstantinos Papamichael; Georgios Kourtis; Eleni N Albani; Afroditi Orfanidou; Maria Saridi; Konstantinos H Katsanos; Dimitrios K Christodoulou Journal: Ann Gastroenterol Date: 2021-12-06