Systematic review with meta-analysis: loss of response and requirement of anti-TNFα dose intensification in Crohn’s disease

Abstract

Overall, around one-third of CD patients experience a LOR and required dose intensification in primary anti-TNF-α responders.

Long‐term efficacy and safety of vedolizumab in patients with inflammatory bowel diseases: A real‐life experience from a tertiary referral center

“…Unfortunately, 10%‐30% of patients are primary non‐responders to anti‐TNF and more than 50% of responders lose control over time . Therefore, new therapeutic agents with different targets of inflammation are deeply needed …”

Real‐world clinical, endoscopic and radiographic efficacy of vedolizumab for the treatment of inflammatory bowel disease

“…However, approximately one‐third of patients are primary nonresponders to anti‐TNF therapy and a significant proportion will experience secondary loss of response over time . For this population of patients, there is an exigent need for novel therapeutic agents with different mechanisms of action …”

Efficacy of a concomitant elemental diet to reduce the loss of response to adalimumab in patients with intractable Crohn's disease

“…Treatment with anti‐TNF‐α agents, however, may cause difficulties, such as primary nonresponse, secondary loss of response (LOR) after achieving remission, and related adverse events, including paradoxical psoriasis . LOR occurs in ~20% of CD patients treated with anti‐TNF‐α agents who achieved remission annually, and the main mechanism of the decreased efficacy is assumed to be due to decreasing blood levels of the anti‐TNF‐α agent coupled with the formation of antidrug antibodies . The SONIC study (The Study of Biologic and Immunomodulator Naive Patients in Crohn's Disease) and following studies demonstrated that combination therapy with IFX (chimeric IgG1 monoclonal antibody) and an immunomodulator effectively prevents LOR, and the pharmacokinetic data regarding their combination were better than for IFX monotherapy .…”

“…[4][5][6][7] LOR occurs in ~20% of CD patients treated with anti-TNF-α agents who achieved remission annually, and the main mechanism of the decreased efficacy is assumed to be due to decreasing blood levels of the anti-TNF-α agent coupled with the formation of antidrug antibodies. [7][8][9][10] The SONIC study (The Study of Biologic and Immunomodulator Naive Patients in Crohn's Disease) and following studies demonstrated that combination therapy with IFX (chimeric IgG1 monoclonal antibody) and an immunomodulator effectively prevents LOR, and the pharmacokinetic data regarding their combination were better than for IFX monotherapy. 2, 11 On the other hand, Matsumoto et al [DIAMOND study (Deep Remission of Immunomodulator and Adalimumab Combination Therapy for Crohn's Disease)] 12 recently reported that remission induction does not differ between combination therapy and ADA (fully human IgG1 monoclonal antibody) monotherapy at 52 weeks.…”