Carmen Yagüe Caballero, Santiago García López, Ana Royo Esteban, Laura Figueras Panillo, Pilar Nos, Luisa de Castro, M Dolores Martín-Arranz, Manuel Barreiro-de Acosta, Elena Ricart, Ruth de Francisco, Eva Iglesias, Antonio Giordano, Pilar Varela, Iago Rodríguez-Lago, Montserrat Rivero, Beatriz Sicilia, Merce Navarro-Llavat, Isabel Vera, Carles Suria, Jordi Guardiola, Jesús Barrio, Margalida Calafat, Ana Gutiérrez, Xavier Calvet, David Rafael de la Cruz, Francisco Mesonero, Cristina Martínez Pascual, Javier P Gisbert, Carla J Gargallo-Puyuelo, David Monfort I Miquel, Mónica Sierra, Laura Arranz, Cristina Rodríguez-Gutiérrez, Rufo Lorente, Fernando Bermejo, Lucía Márquez-Mosquera, Gisela Torres Vicente, José Lázaro Pérez-Calle, José M Huguet, Laura Ramos, Ángel Ponferrada-Díaz, Daniel Ceballos, Mª Teresa Diz-Lois Palomares, Eva Sesé Abizanda, Pablo Vega, Ramón Pajares, Javier Santos Fernández, Elena Betoré, David Busquets, Olga Merino, Carlos Martínez-Flores, Yamile Zabana, Manuela Josefa Sampedro González, Jone Ortiz de Zarate, Ana Fuentes Coronel, Empar Sainz Arnau, Daniel Carpio, Nuria Jiménez, Ignacio Marín-Jiménez, Luis Bujanda, Raquel Camargo Camero, Martín Irabien, María Abanades Tercero, Benito Velayos Jiménez, Pilar Robledo Andres, Ana María Trapero, Pedro G Delgado-Guillena, Luís Hernández Villalba, Margarita Menacho, Nuria Rull Murillo, Carles Leal, Cristina Alba, Rosa Gómez Espín, Alfredo J Lucendo, Manuel Van Domselaar, Laura García Alles, Eduardo Iyo Miyashiro, Ana Crespo Catalá, Pau Gilabert, Daniel Martín Rodríguez, Víctor Manuel Navas-López, María Calvo Iñiguez, Daniel Ginard, Teresa Martínez Pérez, Eugeni Domènech, Diego Casas Deza
Anti-TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first-line therapy or after another anti-TNF agent, especially in UC.
BACKGROUND: The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti-TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti-TNF treatment in this scenario.
METHODS: Multicentre study based on data from the ENEIDA registry. Patients who received second-line anti-TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second-line anti-TNF after another anti-TNF and patients receiving first-line anti-TNF therapy. Treatment durability and short- and long-term clinical effectiveness were assessed.
RESULTS: Sixty-six Crohn's disease patients and 117 UC patients receiving anti-TNF after other MOA were included. In CD, second-line anti-TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first-line anti-TNF therapy (HR 1.55; 95% CI, 1.05-2.30), without significant differences in short- or long-term clinical effectiveness. In UC, anti-TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first-line anti-TNF therapy (HR 1.69; 95% CI, 1.31-2.19) and with anti-TNF after another anti-TNF agent (HR 1.91; 95% CI, 1.48-2.48), its remission rates significantly lower at both short- and long-term follow-up (p < 0.001).
CONCLUSIONS: Anti-TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first-line therapy or after another anti-TNF agent, especially in UC.