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Fourteen-Year Anti-TNF Therapy in Crohn’s Disease Patients: Clinical Characteristics and Predictive Factors

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Abstract

Background

Crohn’s disease (CD) is an intractable disease that requires long-term treatment. Tumor necrosis factor (TNF) inhibitors have strong efficacy and are widely used for CD treatment. However, a loss of response is one of the issues in long-term TNF therapy. To identify the factors affecting the efficacy of long-term CD treatment with TNF inhibitors, we conducted a retrospective study of treatment outcomes and clinical factors using clinical data over a 14-year period.

Methods

Clinical characteristics and factors for surgery, hospitalization, and TNF inhibitor treatment discontinuation were examined in 219 biologic-naïve patients who were treated with TNF inhibitors at our hospital before October 2014.

Results

Treatment persistence rates with no hospitalization, surgery, or dose escalation were 60.7, 25.9, and 17.3% for 1, 5, and 10 years, respectively; these rates did not differ between infliximab (IFX) and adalimumab. In patients receiving IFX dose escalation, 1- and 5-year persistence rates were approximately 90.4 and 65.1%, respectively. Previous surgery (OR = 1.45, P = 0.043) was identified as a risk factor for surgery, male sex (OR = 0.70, P = 0.044) and previous surgery (OR = 1.51, P = 0.03) were risk factors for hospitalization, and perianal fistula (OR = 1.39, P = 0.049) was the risk factor for TNF inhibitor treatment discontinuation.

Conclusions

The durability of anti-TNF therapy in CD patients remains a problem, and treatment optimization that includes dose escalation should be carefully examined depending on patient characteristics and the timing of optimization.

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References

  1. Peyrin-Biroulet L, Cieza A, Sandborn WJ, et al. International Programme to Develop New Indexes for Crohn’s Disease [IPNIC] group. Development of the first disability index for inflammatory bowel disease based on the international classification of functioning, disability and health. Gut. 2012;61:241–247.

    Article  PubMed  Google Scholar 

  2. Ben-Horin S, Chowers Y. Review article: loss of response to anti-TNF treatments in Crohn’s disease. Aliment Pharmacol Ther. 2011;33:987–995.

    Article  CAS  PubMed  Google Scholar 

  3. Hazlewood GS, Rezaie A, Borman M, et al. Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn’s disease: a network meta-analysis. Gastroenterology. 2015;148:344–354.

    Article  CAS  PubMed  Google Scholar 

  4. Suzuki Y, Matsui T, Ito H, et al. Circulating interleukin 6 and albumin, and infliximab levels are good predictors of recovering efficacy after dose escalation infliximab therapy in patients with loss of response to treatment for Crohn’s disease: a prospective clinical trial. Inflamm Bowel Dis. 2015;21:2114–2122.

    Article  PubMed  Google Scholar 

  5. Hibi T, Sakuraba A, Watanabe M, et al. C-reactive protein is an indicator of serum infliximab level in predicting loss of response in patients with Crohn’s disease. J Gastroenterol. 2014;49:254–262.

    Article  CAS  PubMed  Google Scholar 

  6. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn’s disease. Gastroenterology. 2006;130:650–656.

    Article  PubMed  Google Scholar 

  7. Veloso FT, Ferreira JT, Barros L, et al. Clinical outcome of Crohn’s disease: analysis according to the vienna classification and clinical activity. Inflamm Bowel Dis. 2001;7:306–313.

    Article  CAS  PubMed  Google Scholar 

  8. Solberg IC, Vatn MH, Hoie O, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5:1430–1438.

    Article  PubMed  Google Scholar 

  9. Greenstein AJ, Lachman P, Sachar DB, et al. Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut. 1988;29:588–592.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Louis E, Michel V, Hugot JP, et al. Early development of stricturing or penetrating pattern in Crohn’s disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype. Gut. 2003;52:552–557.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Romberg-Camps MJ, Dagnelie PC, Kester AD, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol. 2009;104:371–383.

    Article  CAS  PubMed  Google Scholar 

  12. Chow DK, Sung JJ, Wu JC, et al. Upper gastrointestinal tract phenotype of Crohn’s disease is associated with early surgery and further hospitalization. Inflamm Bowel Dis. 2009;15:551–557.

    Article  PubMed  Google Scholar 

  13. Golovics PA, Mandel MD, Lovasz BD, et al. Is hospitalization predicting the disease course in Crohn’s disease? Prevalence and predictors of hospitalization and re-hospitalization in Crohn’s disease in a population based inception cohort between 2000–2012. Gastroenterology. 2014;146:S–438.

    Google Scholar 

  14. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–1395.

    Article  CAS  PubMed  Google Scholar 

  15. Roblin X, Marotte H, Leclerc M, et al. Combination of C-reactive protein, infliximab trough levels, and stable but not transient antibodies to infliximab are associated with loss of response to infliximab in inflammatory bowel disease. J Crohns Colitis. 2015;9:525–531.

    Article  CAS  PubMed  Google Scholar 

  16. Dulai PS, Siegel CA, Peyrin-Biroulet L. Anti-tumor necrosis factor-α monotherapy versus combination therapy with an immunomodulator in IBD. Gastroenterol Clin North Am. 2014;43:441–456.

    Article  PubMed  Google Scholar 

  17. Dulai PS, Siegel CA, Colombel JF, et al. Systematic review: monotherapy with antitumour necrosis factor α agents versus combination therapy with an immunosuppressive for IBD. Gut. 2014;63:1843–1853.

    Article  CAS  PubMed  Google Scholar 

  18. Matsumoto T, Motoya S, Watanabe K, et al. Adalimumab monotherapy and a combination with azathioprine for Crohn’s disease: a prospective, randomized trial. J Crohn’s Colitis. 2016;10:1259–1266.

    Article  Google Scholar 

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Acknowledgments

We would like to express special thanks to the medical clerk Ms. Emu Ikarigawa who was extremely helpful in gathering clinical information from the study patients. This study was supported in part by Health and Labour Sciences Research Grants for research on intractable diseases from the Ministry of Health, Labour, and Welfare of Japan.

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Authors and Affiliations

  1. Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan

    Aisaku Osamura & Yasuo Suzuki

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  1. Aisaku Osamura
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  2. Yasuo Suzuki
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Correspondence to Yasuo Suzuki.

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Osamura, A., Suzuki, Y. Fourteen-Year Anti-TNF Therapy in Crohn’s Disease Patients: Clinical Characteristics and Predictive Factors. Dig Dis Sci 63, 204–208 (2018). https://doi.org/10.1007/s10620-017-4846-x

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