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P530. Effectiveness of anti-TNF drugs in Crohn's disease (CD) patients who did not achieve remission with the first anti-TNF

M. R-Grau1, M. Chaparro1, F. Mesonero2, M. Barreiro-de Acosta3, L. Castro4, I. Vera5, M. Castro6, E. Domènech7, N. Manceñido8, C. Taxonera9, J.L. Pérez10, J. Barrio11, R. De Francisco12, O. Merino13, L. Oltra14, C. Saro15, F. Bermejo16, V. García17, D. Ginard18, A. Gutiérrez19, X. Calvet20, J.P. Gisbert1, 1Hospital Universitario de la Princesa-IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain, 3Hospital Universitario Clínico de Santiago, Gastroenterology, Santiago de Compostela, Spain, 4Hospital Virgen Macarena, Gastroenterology, Sevilla, Spain, 5Hospital Universitario Puerta de Hierro, Gastroenterology, Madrid, Spain, 6Hospital Universitario de Valme, Gastroenterology, Sevilla, Spain, 7Hospital Universitario Germans Trias i Pujol, Gastroenterology and CIBEREHD, Badalona, Spain, 8Hospital Universitario Infanta Sofía, Gastroenterology, Madrid, Spain, 9Hospital Universitario Clínico San Carlos, Gastroenterology, Madrid, Spain, 10Hospital Universitario Fundación Alcorcón, Gastroenterology, Madrid, Spain, 11Hospital Universitario Rio Hortega, Gastroenterology, Valladolid, Spain, 12Hospital Universitario Central de Asturias, Gastroenterology, Oviedo, Spain, 13Hospital Universitario Cruces, Gastroenterology, Vizcaya, Spain, 14Hospital de Manises, Gastroenterology, Valencia, Spain, 15Hospital de Cabueñes, Gastroenterology, Gijón, Spain, 16Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain, 17Hospital Universitario Reina Sofía, Gastroenterology, Córdoba, Spain, 18Hospital Universitario de Son Espases, Gastroenterology, Mallorca, Spain, 19Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain, 20Corporació Sanitària Parc Taulí, Gastroenterology, Sabadell, Spain

Background

In CD patients that do not achieve remission with an anti-TNF, an attempt with a 2nd anti-TNF could be considered. However, the effectiveness of this strategy remains unclear.

Aim: To evaluate the short-term effectiveness of anti-TNF drugs in CD patients who did not achieve remission with the 1st anti-TNF and to assess the durability of the response in those patients who achieved remission in the short-term with the 2nd anti-TNF.

Methods

Retrospective, multicenter study. The response to the 2nd anti-TNF was evaluated by the Harvey–Bradshaw index for luminal disease, and by the Fistula Drainage Assessment index for perianal disease. Short-term response was assessed after the induction doses and long-term response at the end of follow-up with the 2nd anti-TNF. Predictive factors of remission in the short-term were identified by logistic regression analysis. Patients that achieved remission in the short-term were considered for the log-term study. Long-term remission maintenance was assessed using Kaplan–Meier analysis. Cox-regression analysis was performed to identify predictive factors for loss of efficacy.

Results

106 patients were included: 43% ileocolonic location, 49% inflammatory behaviour, 38% smokers and 55% with perianal disease. The majority of patients (62%) received infliximab as the 1st anti-TNF. The anti-TNF dosage had been escalated in 55% of patients before switching to the 2nd one. The 1st anti-TNF had been stopped in 55% of patients due to non-primary response, and due to partial response in 45%. In the short-term, remission was achieved in 51% of patients. The probability of response of response with the 2nd anti-TNF was lower in patients with previous non-primary response (OR = 2.7, p = 0.04), in those receiving the anti-TNF for perianal disease (OR = 0.08, p = 0.003) and in those with previous surgery (OR = 0.3, p = 0.03). The probability of maintaining remission was 75%, 68% and 64% at 12, 18 and 24 months. The incidence rate of loss of remission was 23% per patient-year of follow-up. Smoking habit was associated with a higher risk of loss of remission (HR = 2.6, p = 0.04).

Conclusion

Fifty percent of patients achieve remission with a 2nd anti-TNF after having had non-response or partial response to a 1st anti-TNF. This strategy is less effective in patients with null response to the 1st anti-TNF, those with previous surgery or receiving the drug for perianal disease. A relevant proportion of patients lose response in the long-term, the risk being higher among smokers.