Do not assume symptoms indicate failure of anti-tumor necrosis factor therapy in Crohn's disease (original) (raw)
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Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Crohn's disease (CD) is a chronic idiopathic inflammatory bowel disease (IBD) which affects any site of the gastrointestinal tract and occasionally extraintestinal organs. The natural history of CD varies remarkably but a considerable proportion of patients develop complications leading to hospitalizations and surgeries, impaired quality of life, and disability. In these patients, effective medical therapy should aim beyond control of clinical symptoms to include induction and maintenance of steroid-free clinical and serological remission and mucosal healing, as this has shown to reduce complications, hospitalizations and surgeries, and to decrease the risk of colorectal cancer, at least in the short term. This therapeutic goal can be achieved in a considerable proportion of patients with anti-tumor necrosis factor (TNF)-α agents if applied early in the disease course. Clinical recommendations from a panel of Greek IBD experts are herein provided, regarding the clinical profiles...
Scientific Reports, 2021
Crohn’s disease (CD) is often complicated by strictures and associated with increased risk for surgery. Inflammatory strictures respond to medical therapy, and anti-tumor necrosis factor (TNF) therapy is often used after the failure of steroids. However, data on efficacy of anti-TNF therapy in stricturing CD is limited. We retrospectively analysed the records of patients with stricturing CD who were treated with anti-TNF therapy and were prospectively followed from January 2005 to July 2020. Treatment success was defined as continuation of anti-TNF without the requirement for steroids or parenteral nutrition, switch to other anti-TNF, endoscopic dilation, surgery and severe adverse events leading to the withdrawal of anti-TNF. Fifty-nine patients were included [50-infliximab, 9-adalimumab; mean age-30.1 ± 15 years; males-69.5%; median disease duration-124 (range 30–396) months; median follow-up duration-42 (range 8–180) months]. Ileum was the most common site of stricture (69.5%), 2...
Outcomes of Anti-TNF Treatment in Crohn’s Disease: A Real-Life, Tertiary Center Experience
Journal of Enterocolitis, 2022
Objective: The main treatment option for Crohn's Disease is anti-tumor necrosis factor agents. In this study, we assess the real-life experience of anti-tumor necrosis factor treatment in a tertiary center. Methods: We enrolled the patients retrospectively who were followed up at our Inflammatory bowel disease-specific gastroenterology outpatient clinic between October 2006 and April 2019. We collected demographic and clinical data from the electronic hospital database and hardcopy of patient files. The primary outcomes of this study are short-term and long-term efficacy. Secondary outcomes are the safety of treatments and indications of anti-tumor necrosis factor initiation. Results: A total of 870 Crohn's disease patients were screened, 236 were exposed to anti-tumor necrosis factor, and 200 patients were included for the final analysis. The median follow-up period of anti-tumor necrosis factor treatment was 55 months (range: 4-168). A total of 133 patients received infliximab, 97 received adalimumab, and 11 received certolizumab as first-, second-, or third-line treatment. In total, 6 patients (4.2%) were primary unresponsive and 15 (10.6%) patients were secondary unresponsive to infliximab; 3 patients (2.8%) were primary unresponsive and 14 patients (13.3%) were secondary unresponsive to adalimumab; and 2 (18%) patients were primary unresponsive and 1 (9%) patient was secondary unresponsive to certolizumab. The most common indication of anti-tumor necrosis factor treatment was fistula formation (47.7%, n = 87). However, 63 (50.0%) fistulizing patients had no response to anti-tumor necrosis factor treatment. Conclusion: Two-thirds of the patients had treatment response, and no significant difference was seen between agents. Half of the patients has fistulizing disease and 50% of them were non-responders.
United European Gastroenterology Journal
Background There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn’s disease. Aim The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn’s disease complicated with symptomatic strictures. Methods In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn’s disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. Results Overall, 262 patients with Crohn’s disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab ( N = 141, 54%) or adalimumab ( N = 121, 46%). The treatment was e...
Inflammatory Bowel Diseases, 2012
Background: Symptom relief is the traditional treatment goal in Crohn's disease (CD). New goals including mucosal healing and bowel preservation are now achievable with tumor necrosis factor (TNF) antagonists. Infliximab and adalimumab are approved as second-line treatments for severe, active CD. Certolizumab pegol is approved only in the U.S. and Switzerland as second-line treatment for moderate-to-severe, active CD. Data from trials of infliximab suggest that high-risk patients and patients with active inflammation (CRP elevation and/or ileocolonic ulcers) may benefit from earlier use of this drug.
Digestive and Liver Disease, 2016
Background: Soluble tumour necrosis factor-␣ (sTNF-␣) has been reported to increase in the course of anti-TNF-␣ therapy for rheumatoid and skin diseases. Aims: To assess changes in sTNF-␣ and clinical efficacy of anti-TNF-␣ agents in Crohn's disease (CD). Methods: Sixty-four patients on infliximab or adalimumab were analyzed. Clinical outcomes were assessed by using CD Activity Index after the induction therapy and at week 52. sTNF-␣ was measured before and after the induction therapy with high-sensitivity immunoassay. Results: In the majority of patients, sTNF-␣ increased significantly. Those with the greatest increase were more likely to experience long-term response, were more often treated with infliximab, had less frequently isolated small bowel CD, and tended to have sTNF-␣ levels at baseline that correlated with C-reactive protein. Conclusions: Neutralization of sTNF-␣ does not seem to be critical for the efficacy of anti-TNF-␣ therapy in CD. Paradoxically-an increase in sTNF-␣ may reflect an ongoing process that is beneficial for the clinical outcome.
Update on anti-tumor necrosis factor agents in Crohn disease
Gastroenterology clinics of North America, 2014
Anti-tumor necrosis factor-α (TNF) agents, including infliximab, adalimumab, and certolizumab pegol, are effective medications for the management of moderate to severe Crohn disease (CD). They are effective in inducing and maintaining clinical remission, inducing mucosal healing, improving quality of life, and reducing the risk of hospitalization and surgery in adult and pediatric patients with CD. Future research into comparative effectiveness of different agents, as well as better understanding of predictors of response, is warranted to allow optimization of therapeutic response.
Biomedecine & Pharmacotherapy, 2007
To determine whether anti-tumor necrosis factors induce clinical response and remission in patients with Crohn's disease, PUBMED, OVID, and SCOPUS databases were searched for studies investigated the efficacy of anti-tumor necrosis factors on CD. Data were collected from 1966 to 2005 (up to 31 December). Types of outcome investigated were response (decrease in CDAI score !70 points) and remission (CDAI score 150 points) 2 and 4 weeks after drug administration. The criteria for inclusion of studies in this analysis were exposure of patients with CD to any therapeutic dosage of any anti-tumor necrosis factors (infliximab, cetrolizumab, CDP870, CDP571, etanercept, onarcept).The results showed that anti-tumor necrosis factors have improved only clinical response 2 weeks after administration of these drugs statistically, but their effects on clinical remission after 2 weeks and response and remission after 4 weeks have not been significant. It seems that anti-tumor necrosis factors are not effective for induction of response and remission in patients with Crohn's disease.
Canadian Journal of Gastroenterology, 2009
BACKGROUND: Guidelines regarding the use of infliximab in Crohn’s disease were previously published by the Canadian Association of Gastroenterology in 2004. However, recent clinical findings and drug developments warrant a review and update of these guidelines.OBJECTIVE: To review and update Canadian guidelines regarding the use of tumour necrosis factor-alpha antibody therapy in both luminal and fistulizing Crohn’s disease.METHODS: A consensus group of 25 voting participants developed a series of recommendation statements that addressed pertinent clinical questions and gaps in existing knowledge. An iterative voting and feedback process was used in advance of the consensus meeting in conjunction with a systematic literature review to refine the voting statements. These statements were brought to a formal consensus meeting held in Montreal, Quebec (March 2008), wherein each statement underwent discussion, reformulation, voting and subsequent revision until group consensus was obtain...