Aisaku Osamura1, Yasuo Suzuki2. 1. Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan. 2. Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan. yasuo-suzuki@sakura.med.toho-u.ac.jp.
Abstract
BACKGROUND: Crohn's disease (CD) is an intractable disease that requires long-term treatment. Tumor necrosis factor (TNF) inhibitors have strong efficacy and are widely used for CD treatment. However, a loss of response is one of the issues in long-term TNF therapy. To identify the factors affecting the efficacy of long-term CD treatment with TNF inhibitors, we conducted a retrospective study of treatment outcomes and clinical factors using clinical data over a 14-year period. METHODS: Clinical characteristics and factors for surgery, hospitalization, and TNF inhibitor treatment discontinuation were examined in 219 biologic-naïve patients who were treated with TNF inhibitors at our hospital before October 2014. RESULTS: Treatment persistence rates with no hospitalization, surgery, or dose escalation were 60.7, 25.9, and 17.3% for 1, 5, and 10 years, respectively; these rates did not differ between infliximab (IFX) and adalimumab. In patients receiving IFX dose escalation, 1- and 5-year persistence rates were approximately 90.4 and 65.1%, respectively. Previous surgery (OR = 1.45, P = 0.043) was identified as a risk factor for surgery, male sex (OR = 0.70, P = 0.044) and previous surgery (OR = 1.51, P = 0.03) were risk factors for hospitalization, and perianal fistula (OR = 1.39, P = 0.049) was the risk factor for TNF inhibitor treatment discontinuation. CONCLUSIONS: The durability of anti-TNF therapy in CD patients remains a problem, and treatment optimization that includes dose escalation should be carefully examined depending on patient characteristics and the timing of optimization.
BACKGROUND:Crohn's disease (CD) is an intractable disease that requires long-term treatment. Tumor necrosis factor (TNF) inhibitors have strong efficacy and are widely used for CD treatment. However, a loss of response is one of the issues in long-term TNF therapy. To identify the factors affecting the efficacy of long-term CD treatment with TNF inhibitors, we conducted a retrospective study of treatment outcomes and clinical factors using clinical data over a 14-year period. METHODS: Clinical characteristics and factors for surgery, hospitalization, and TNF inhibitor treatment discontinuation were examined in 219 biologic-naïve patients who were treated with TNF inhibitors at our hospital before October 2014. RESULTS: Treatment persistence rates with no hospitalization, surgery, or dose escalation were 60.7, 25.9, and 17.3% for 1, 5, and 10 years, respectively; these rates did not differ between infliximab (IFX) and adalimumab. In patients receiving IFX dose escalation, 1- and 5-year persistence rates were approximately 90.4 and 65.1%, respectively. Previous surgery (OR = 1.45, P = 0.043) was identified as a risk factor for surgery, male sex (OR = 0.70, P = 0.044) and previous surgery (OR = 1.51, P = 0.03) were risk factors for hospitalization, and perianal fistula (OR = 1.39, P = 0.049) was the risk factor for TNF inhibitor treatment discontinuation. CONCLUSIONS: The durability of anti-TNF therapy in CDpatients remains a problem, and treatment optimization that includes dose escalation should be carefully examined depending on patient characteristics and the timing of optimization.
Entities:
Keywords:
Adalimumab; Crohn’s disease; Infliximab; Loss of response; Risk factor
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