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P492 Influence of the interval of time between the first and the second anti-TNF in the response to treatment in patients with inflammatory bowel disease

I. Baston*1, N. Mora-Cuadrado2, C. Calviño1, V. Mauriz-Barreiro1, D. De la Iglesia1, J. Gonzalez3, R. Ferreiro-Iglesias1, J. E. Dominguez-Munoz1, M. Barreiro-de Acosta1

1University Hospital, Gastroenterology, Santiago de Compostela, Spain, 2Clinic Hospital, Valladolid, Spain, 3University Hospital, Pharmacy, Santiago de Compostela, Spain

Background

There is no evidence about the time that it is reasonable to wait until starting the second anti TNF in case of loss of response. The aim of our study was to evaluate whether the time between the change from the first to the second anti TNF had an influence on the risk of treatment failure and the rate of adverse events or severe infections.

Methods

A retrospective, observational single-centre study was designed. Inclusion criteria were all adult patients who started treatment with Infliximab (IFX) or Adalimumab (ADA) for moderate-to-severe IBD and who required a change in anti-TNF (IFX or ADA) therapy due to loss of response. Exclusion criteria were patients under other types of anti-TNF treatment or those who had received treatment for different indications. We defined three groups of periods based on the interval of time before starting the second anti-TNF-treatment: Group A: very early (≤14 days), Group B: early (15–30 days) and Group C: late (30–60 days). Patients for whom the interval of time was over 60 days were excluded. Treatment failure after the second anti-TNF was defined as the need for dose intensification, surgery resection, or therapy removal for ineffectiveness. The influence of the first anti TNF agent (IFX or ADA) and the existence of adverse events or infections were also evaluated. Results are shown as percentages, median, range and Hazard Ratio (CI 95%). Fisher test and Cox Regression Analysis were also performed.

Results

75 patients (63% CD) were consecutively included (mean age 45). Forty-seven initially under treatment with IFX and 28 with ADA. Twelve patients were included in Group A, 25 in Group B and 38 in Group C. Treatment failure was observed in 43 (57.3%) patients (30 due to intensification, 3 due to primary failure and 2 nudo to surgery). In Cox Regression, time of change of anti-TNF was not associated with increased risk of treatment failure (HR 1.02; 95% CI 0.37–2.78) with a median time until loss of response of 365.4 days in Group A, 377.2 days in group B and 491 days in Group C.

Cox regression of influence of interval of time between first and second anti-TNF and treatment failure

No differences were found in starting with IFX (HR 1.31; 95% CI 0.68–2.54) or ADA (HR 0.74; 95% CI 0.40–1.39) There were 8 adverse events that forced the stopping of treatment: 3 in Group A, 3 in Group B and 2 in Group C (p = 0.12). No infections that required hospitalisation were observed.

Conclusion

The interval of time between the first and the second anti-TNF had no influence on either the rates of failure to treatment, the rates of adverse events or the rates of infections.