title: Analysis of TNF-antagonist switch over time and associated risk factors in the Swiss Inflammatory Bowel Disease Cohort.
abstract: OBJECTIVE
  Limited data from large cohorts are available on tumor necrosis factor (TNF) antagonists (infliximab, adalimumab, certolizumab pegol) switch over time. We aimed to evaluate the prevalence of switching from one TNF antagonist to another and to identify associated risk factors.
  
  
  METHODS
  Data from the Swiss Inflammatory Bowel Diseases Cohort Study (SIBDCS) were analyzed.
  
  
  RESULTS
  Of 1731 patients included into the SIBDCS (956 with Crohn's disease [CD] and 775 with ulcerative colitis [UC]), 347 CD patients (36.3%) and 129 UC patients (16.6%) were treated with at least one TNF antagonist. A total of 53/347 (15.3%) CD patients (median disease duration 9 years) and 20/129 (15.5%) of UC patients (median disease duration 7 years) needed to switch to a second and/or a third TNF antagonist, respectively. Median treatment duration was longest for the first TNF antagonist used (CD 25 months; UC 14 months), followed by the second (CD 13 months; UC 4 months) and third TNF antagonist (CD 11 months; UC 15 months). Primary nonresponse, loss of response and side effects were the major reasons to stop and/or switch TNF antagonist therapy. A low body mass index, a short diagnostic delay and extraintestinal manifestations at inclusion were identified as risk factors for a switch of the first used TNF antagonist within 24 months of its use in CD patients.
  
  
  CONCLUSIONS
  Switching of the TNF antagonist over time is a common issue. The median treatment duration with a specific TNF antagonist is diminishing with an increasing number of TNF antagonists being used.
authors.affiliation: Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hiroz
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fournier
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Safroneeva
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015992:Body Mass Index; D000068582:Certolizumab Pegol; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D057210:Delayed Diagnosis; D057915:Drug Substitution / Q000706:statistics & numerical data*; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007223:Infant; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
keywords: Crohn’s disease; drug switch; loss of response; side effects; tumor necrosis factor; tumor necrosis factor antagonist; ulcerative colitis