Biologic-naïve IBD patients on anti-TNFα warrant treatment intensification

Treatment intensification is needed in around one-third of biologic-naïve patients with inflammatory bowel disease (IBD) who had received initial antitumour necrosis factor α (anti-TNFα) medication, a recent study has found.

Researchers conducted a retrospective observational analysis of 310 IBD patients (median age 44.0 years, 53.5 percent men), of whom 194 had Crohn’s disease (CD) and 116 ulcerative colitis (UC). The respective subgroups were followed up for a median of 59.8 and 59.8 months after treatment administration.

During follow-up, 28.9 percent and 37.1 percent of CD and UC patients, respectively, needed anti-TNFα treatment intensification. The most common intensification strategy combined increasing doses and shortening dose intervals; such a strategy was applied to more than 40 percent of patients. The need for intensification arose significantly earlier in UC patients (5.3 vs 14.3 months; p=0.028).

Moreover, 47.4 percent and 56.0 percent of CD and UC patients, respectively, discontinued anti-TNFα medication. Notably, discontinuation for reasons other than disease remission was reported in 40.7 percent and 40.5 percent of the corresponding subgroups.

Loss of response (LOR) was the most common reason for treatment discontinuation, accounting for 13.4 percent in CD patients, 15.5 percent in UC patients, and 14.2 percent overall. LOR explained over a third of the discontinuations due to reasons other than remission. In comparison, only 9.0 percent of the total cohort discontinued due to side effects.

“A substantial proportion of IBD patients could benefit from alternative first-line biologic therapies,” the researchers said. “To select the most appropriate IBD treatment it would be essential to identify biomarkers able to predict the long-term success with the different available biologic agents.”