Long-term Durability of Infliximab Treatment in Crohn's Disease and Efficacy of Dose “Escalation” in Patients Losing Response

Chaparro, María; Panés, Julián; García, Valle; Mañosa, Míriam; Esteve, María; Merino, Olga; Andreu, Montserrat; Gutiérrez, Ana; Gomollón, Fernando; Cabriada, José Luis; Montoro, Miguel; Mendoza, Juan L.; Nos, Pilar; Gisbert, Javier P.

doi:10.1097/mcg.0b013e3181ebaef9

Cited by 117 publications

(80 citation statements)

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“…A majority of studies classified smoker or non-smoker by smoking status at the time of drug initiation, but some studies considered ex-smoking status. [7,8,[10][11][12] Some studies defined the amount of smoking as more than 5 cigarettes per day within 6 months from initiation of drug administration, [16,19,20,28,29] more than 7 cigarettes per week, [18,26] more than 1 cigarette per day, [17] or the presence of smoking without considering cigarette numbers. [13][14][15][22][23][24][25]27,[31][32][33][34] These variable smoking definitions could contribute to the discrepancy in the study results.…”

Section: Discussionmentioning

confidence: 99%

Impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis or Crohn's disease

Song

Sohn

Kim

et al. 2014

Transl Clin Pharmacol

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These authors contributed equally as co-first authorsCigarette smoking may be associated with the augmentation of pro-inflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-α), which may affect the outcomes of pharmacological agents such as TNF-α inhibitors. The purpose of this study was to investigate the impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis (RA) or Crohn's disease (CD). We used systematic literature review methods. A total of 1,147 articles were selected after exclusion of duplicates through a database search. Among them, 28 articles were finally selected through a review of titles and abstracts and a subsequent review of full articles. The effectiveness of TNF-α inhibitors in patients with RA or CD among the selected articles was summarized by their smoking status. Meta-analysis was performed with random effect model. When current smokers were compared with non-smokers for response after adjustments through meta-analysis among patients with RA, current smokers had 59% less response than non-smokers with statistical significance (Pooled adjusted OR=0.41, 95% CI=0.17-0.95). In patients with CD, current smokers tended to have lower clinical response than non-smokers, but statistical significance was not shown. In subgroup analyses for luminar CD or fistulizing CD, current smokers tended to have a lower response in luminar CD (Pooled OR=0.62, 95% CI=0.34-1.14), but smoking status was not associated with drug response in fistulizing CD. This study raises awareness of the adverse effects of smoking in terms of clinical response in patients treated with TNF-α inhibitors.

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Section: Discussionmentioning

confidence: 99%

Impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis or Crohn's disease

Song

Sohn

Kim

et al. 2014

Transl Clin Pharmacol

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“…2 In addition, the way biologics were used in this series contradict the assumption that this experience represents their 'real use' in Crohn's disease. [2][3][4][5][6][7] Firstly, cotreatment with immunosuppressors was given in just 16% of cases in the infliximab group. 2,6 Secondly, and surprisingly, only 77% of the infliximab-treated patients were able to complete the induction treatment, mainly due to severe adverse events in eight (18%) patients; this is not generally seen in clinical series.…”

Section: Acknowledgementmentioning

confidence: 99%

“…[2][3][4][5][6][7] Firstly, cotreatment with immunosuppressors was given in just 16% of cases in the infliximab group. 2,6 Secondly, and surprisingly, only 77% of the infliximab-treated patients were able to complete the induction treatment, mainly due to severe adverse events in eight (18%) patients; this is not generally seen in clinical series. 2,3 Thirdly, the definition of loss of response considered the same interval of time (2 weeks) for both drugs, ignoring their different biological behaviour.…”

Section: Acknowledgementmentioning

confidence: 99%

“…4 Finally, in the adalimumab group, 16 patients dropped out before the scheduled 54 weeks for clinical worsening or loss of response (n = 8), in spite of which therapy was never intensified. 5,6 All these considerations prevent us to accept the conclusion that 'the efficacy of infliximab and adalimumab is comparable.' As the authors correctly state, 'future prospective double-blind studies in patients matched for clinical variables are required to further assess the efficacy and safety of different anti-TNFs in CD.'…”

Section: Acknowledgementmentioning

confidence: 99%

“…3 This RIA has been extensively clinically validated in IBD and other diseases. [3][4][5][6] It has a higher sensitivity for anti-IFX Ab detection than bridging and capture ELISAs, and is capable of detecting all subtypes of anti-IFX Ab including monovalent IgG4 Ab, which predominate during long-term immunisations. 7 This subclass of Ab, although detectable in capture ELISA, are not detected in bridging ELISAs.…”

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confidence: 99%

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Letter: infliximab and adalimumab in the management of Crohn's disease – are they really comparable?

López-Sanromán

Gisbert

2012

Aliment Pharmacol Ther

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definite conclusions can be drawn from our findings. However, despite small sample size, no positive trends were observed in our case series whatever the subgroup of patients considered.Based on our results, we thus decided to stop using methotexate for treating psoriasiform lesions associated with antitumour necrosis factor (TNF) therapy in IBD in our centre. We do not believe that anti-TNF switching is a confounding factor when interpreting our data, as suggested by Guerra and Gisbert. This reflects clinical practice, as continuation of anti-TNF treatment is needed in the vast majority of IBD patients.Consistently, anti-TNF therapy withdrawal was associated with a need for surgery in two patients. Our findings simply confirm a drug class effect for these psoriasiform lesions. If methotrexate was effective in treating skin lesions induced by anti-TNF therapy, by definition, it should be effective in patients with ongoing anti-TNF treatment. This was not the case in our eight patients. Finally, our results further highlight that the mechanisms underlying these skin lesions likely differ from those associated with psoriasis vulgaris.In conclusion, despite the limitations to our study and pending large prospective studies addressing this issue, we cannot recommend treating anti-TNF therapy-associated psoriasiform lesions with methotrexate in IBD patients. These skin lesions may require different therapeutic approaches than methotrexate. This will also require further investigation. ACKNOWLEDGEMENTThe authors' declarations of personal and financial interests are unchanged from those in the original article.

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Real‐world efficacy and safety of vedolizumab among patients with inflammatory bowel disease: A single tertiary medical center experience in Central Taiwan

Chiu

Chen

et al. 2020

Adv in Digestive Medicine

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The incidence of IBD is increasing in Eastern countries. The anti-TNF-α biological agents are available in patients with severely active IBD. Recently, the vedolizumab was approved by Taiwan Food and Drug Administration (TFDA). The efficacy and safety of vedolizumab in real-world practice for Asia regions is uncertain. Our primary endpoint is to evaluate the efficacy of vedolizumab for TNF-α exposure and naive patients during induction phase. The secondary endpoints are adverse events, infection, and emergent surgery during induction. We conducted a retrospective observational cohort study from November 2017 to April 2019 in our hospital. We enrolled patients receiving vedolizumab with or without previous anti-TNF-α agent exposure.

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Long-term Durability of Infliximab Treatment in Crohn's Disease and Efficacy of Dose “Escalation” in Patients Losing Response

Abstract: A relevant proportion of CD patients on long-term infliximab treatment loss response. After loss of response, a high proportion of these patients initially respond to infliximab dose escalation. Concurrent immunomodulators may increase and smoking may decrease maintenance of response.

Cited by 117 publications

References 0 publications

Impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis or Crohn's disease

Impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis or Crohn's disease

Letter: infliximab and adalimumab in the management of Crohn's disease – are they really comparable?

Real‐world efficacy and safety of vedolizumab among patients with inflammatory bowel disease: A single tertiary medical center experience in Central Taiwan

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