Skip to Main content Skip to Navigation
Journal articles

Anti-TNF Monotherapy for Crohn's Disease: a 13-year Multicentre Experience

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 antiTNF 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.
Document type :
Journal articles
Complete list of metadatas

https://hal.univ-lorraine.fr/hal-01659113
Contributor : Ngere Ul <>
Submitted on : Friday, December 8, 2017 - 10:08:59 AM
Last modification on : Wednesday, October 14, 2020 - 3:11:43 AM

Links full text

Identifiers

Collections

Citation

Laurent Peyrin-Biroulet, Julia Salleron, Jerome Filippi, Catherine Reenaers, Ophelie Antunes, et al.. Anti-TNF Monotherapy for Crohn's Disease: a 13-year Multicentre Experience. Journal of Crohn's and Colitis, Elsevier - Oxford University Press, 2016, 10 (5), pp.516-524. ⟨10.1093/ecco-jcc/jjw008⟩. ⟨hal-01659113⟩

Share

Metrics

Record views

119