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P610 Factors associated with anti-tumour necrosis factor therapy failure in patients with Crohn’s disease: Does the type of drug have any influence?

I. Baston*, M. Barreiro-de Acosta, D. De la Iglesia, R. Ferreiro, A. Lorenzo, J. E. Dominguez-Munoz

University Hospital Santiago de Compostela, Gastroenterology, Santiago, Spain

Background

Anti-tumour necrosis factor (TNF) monoclonal antibodies are effective drugs for induction and maintenance of remission in Crohn’s disease (CD). However a significant portion of patients do not respond or lose their response during the treatment and predictive factors are not well known. There is no direct data comparing the efficacy between different anti-TNF drugs. The aim of this study was to evaluate the factors associated with anti-TNF therapy failure in anti-TNF naive patients with CD.

Methods

A retrospective, observational single-centre study was designed. Inclusion criteria were all naïve patients older than 17 years old who started treatment with anti-TNF drugs, either infliximab or adalimumab, for moderate-to-severe CD between January 2007 and December 2013. Patients who had been previously treated with another anti-TNF were excluded. Patients who started anti-TNF for different indications like prevention of recurrence or refractory extra-intestinal manifestations, were not included. Treatment failure was defined as the need for dose intensification because of loss of response, surgery resection, or therapy removal for ineffectiveness. The influence of demographic and clinical variables (gender, age, smoking history, and type of biological agent used) on treatment failure was also evaluated. Results are shown as OR and 95% CI and analysed using the Chi-square test and multivariable logistic regression analysis.

Results

In total, 129 CD patients were consecutively included: 72 women (55.8%) and 57 men (44.2%), with a mean age of 35.9 years. Further, 64 treatments were with infliximab (49.6%) and 65(50.4%) with adalimumab. Amongst the patients, there were 52 smokers (40.3%) and 12 former smokers (9.3%). Mean treatment failure was observed in 51 patients (39.5%): 36 because of dose intensification (27.9%); 11 because of surgery (8.5%); and 4 primary failures after anti-TNF induction therapy (3.1%). No factors associated with treatment failure were identified in the multivariate analysis. Similar rates of treatment failure were found between infliximab and adalimumab (p = 0.802).

Conclusion

More than 60% of CD patients maintained response to anti-TNF therapy, and 27% of patients required treatment intensification. No differences were found between infliximab and adalimumab in terms of treatment failure in patients with CD.