title: The efficacy and safety of a third anti-TNF monoclonal antibody in Crohn's disease after failure of two other anti-TNF antibodies.
abstract: BACKGROUND
  Adalimumab (ADA) and certolizumab pegol (CZP) have demonstrated efficacy in Crohn's disease (CD) patients previously treated with infliximab (IFX).
  
  
  OBJECTIVE
  To assess the efficacy and tolerability of a third anti-TNF in CD after failure of and/or intolerance to two different anti-TNF antibodies.
  
  
  METHODS
  Crohn's disease patients who received ADA or CZP after loss of response and/or intolerance to two anti-TNF agent were included in this retrospective study. Data were collected using a standardized questionnaire. Clinical response, duration, safety and reasons for discontinuation were assessed.
  
  
  RESULTS
  Sixty-seven patients treated with CZP (n = 40) or ADA (n = 27) were included. A clinical response was observed in 41 (61%) at week 6 and 34 patients (51%) at week 20. The probability of remaining under treatment at 3 months, 6 months and 9 months was 68%, 60% and 45%, respectively. At the end of follow-up, the third anti-TNF had been stopped in 36 patients for intolerance (n = 13), or failure (n = 23). Two deaths were observed.
  
  
  CONCLUSIONS
  The treatment with a third anti-TNF (CZP or ADA) agent of CD patients, who have experienced loss of response and/or intolerance to two anti-TNF antibodies, has favourable short-term and long-term efficacy. It is an option to be considered in patients with no other therapeutic options.
authors.affiliation: Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France. matthieu.allez@sls.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Allez
authors.forename: S
authors.initials: S
authors.lastname: Vermeire
authors.forename: N
authors.initials: N
authors.lastname: Mozziconacci
authors.forename: P
authors.initials: P
authors.lastname: Michetti
authors.forename: D
authors.initials: D
authors.lastname: Laharie
authors.forename: E
authors.initials: E
authors.lastname: Louis
authors.forename: M-A
authors.initials: MA
authors.lastname: Bigard
authors.forename: X
authors.initials: X
authors.lastname: Hébuterne
authors.forename: X
authors.initials: X
authors.lastname: Treton
authors.forename: A
authors.initials: A
authors.lastname: Kohn
authors.forename: P
authors.initials: P
authors.lastname: Marteau
authors.forename: A
authors.initials: A
authors.lastname: Cortot
authors.forename: C
authors.initials: C
authors.lastname: Nichita
authors.forename: G
authors.initials: G
authors.lastname: van Assche
authors.forename: P
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: M
authors.initials: M
authors.lastname: Lémann
authors.forename: J-F
authors.initials: JF
authors.lastname: Colombel
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000068582:Certolizumab Pegol; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007140:Immunoglobulin Fab Fragments; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol