title: Experience With Anti-TNF-α Biologic Agents in Succession in Patients With Crohn's Disease: A Retrospective Analysis of a Single Center.
abstract: OBJECTIVE
  Our aim was to identify and compare the effectiveness of antitumor necrosis factor biologics when used as initial agents and when used in succession for the treatment of moderate to severe Crohn's disease (CD).
  
  
  BACKGROUND
  Studies directly comparing the efficacy of biologics are lacking. When one biologic loses efficacy, patients are often treated with an alternate biologic. The effectiveness of this strategy has not been thoroughly investigated.
  
  
  METHODS
  This is a retrospective cohort study from a database of 153 patients with CD treated with infliximab, adalimumab, or certolizumab pegol. Response rates determined by physician global assessment were compared between biologics when given as initial agents and after failure of 1 or 2 prior biologics.
  
  
  RESULTS
  There were no significant differences in response between infliximab (64.5%), adalimumab (60.0%), and certolizumab pegol (66.7%) when given as initial biologics. As second-line or third-line agents after prior biologic failure, there was a trend toward increased response with infliximab (83.3%) versus adalimumab (52.7%) and certolizumab pegol (59.4%); however, this did not meet statistical significance. After failure or loss of response of 2 previous biologics, use of a third biologic was still effective with a response rate of 54.2%.
  
  
  CONCLUSIONS
  All 3 biologics have similar efficacy in the treatment of CD when given as initial agents. Infliximab has a trend toward increased response after prior biologic failure; however, this did not meet statistical significance. Even after loss of response or failure of 2 previous biologics, trial of a third alternate biologic is an effective strategy.
authors.affiliation: Division of Gastroenterology, Medicine, Biochemistry and Molecular Biology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: William
authors.initials: W
authors.lastname: Ferges
authors.forename: Saroja Devi
authors.initials: SD
authors.lastname: Rampertab
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shafqet
authors.forename: Qasim
authors.initials: Q
authors.lastname: Salimi
authors.forename: Geoffrey
authors.initials: G
authors.lastname: You
authors.forename: Eleazer
authors.initials: E
authors.lastname: Yousefzadeh
authors.forename: Jerry Q
authors.initials: JQ
authors.lastname: Cheng
authors.forename: Kiron M
authors.initials: KM
authors.lastname: Das
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D000068582:Certolizumab Pegol / Q000009:adverse effects / Q000627:therapeutic use*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D057915:Drug Substitution; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D001688:Biological Products; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol