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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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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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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DOI: https://doi.org/10.1007/s10620-017-4846-x