title: Anti-TNF Monotherapy for Crohn's Disease: a 13-year Multicentre Experience.
abstract: BACKGROUND
  Anti-tumour necrosis factor [TNF] therapy in combination with thiopurine is the most effective strategy for Crohn's disease, but raises safety concerns.
  
  
  METHODS
  In a retrospective multicentre study, we investigated long-term outcome of patients starting anti-TNF monotherapy for Crohn's disease and investigated whether introducing an immunomodulator in patients losing response to anti-TNF monotherapy is effective for resetting immunogenicity.
  
  
  RESULTS
  A total of 350 adult patients with Crohn's disease received either infliximab [n = 178, 51%] or adalimumab [n = 172, 49%] monotherapy. Mean duration of follow-up was 42 months. An immunomodulator was initiated in 53 patients [15%]. At last follow-up, 73.1% [n = 38] were in clinical remission [one patient with missing data]. Multivariate analysis identified anti-TNF type [higher need for starting immunomodulator for infliximab than for adalimumab; p = 0.0058] and first- vs second-/third-/fourth-line anti-TNF therapy [p = 0.014] as predictors of immunomodulator initiation. Among the 18 patients with available data, introduction of an immunomodulator was able to restore infliximab trough level within the therapeutic range and to induce clinical remission in 10 patients [55%]. Cumulative probability of remaining on anti-TNF therapy was 57.9% at 5 years among the 297 patients not starting an immunomodulator during follow-up.
  
  
  CONCLUSIONS
  An immunomodulator was initiated in 15% of patients with Crohn's disease starting anti-TNF monotherapy. Independent predictors of immunomodulator initiation were infliximab use and second-/third-/fourth-line anti-TNF therapy. Resetting immunogenicity with an immunomodulator was effective in half of patients in a sub-study. Persistence of anti-TNF treatment at 5 years was observed in half of the 297 patients not starting an immumodulator in a real-life setting.
authors.affiliation: Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France peyrinbiroulet@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Department of Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.affiliation: Institute for Research on Cancer and Aging, Department of Gastroenterology & Nutrition, Hôpital de l'Archet, Nice, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Filippi
authors.affiliation: Gastroenterology Department, University of Liège, Liège, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Reenaers
authors.affiliation: Institute for Research on Cancer and Aging, Department of Gastroenterology & Nutrition, Hôpital de l'Archet, Nice, France.
authors.forename: Ophélie
authors.initials: O
authors.lastname: Antunes
authors.affiliation: Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Filipe
authors.affiliation: Gastroenterology Department, University of Liège, Liège, Belgium.
authors.forename: Edouard
authors.initials: E
authors.lastname: Louis
authors.affiliation: Institute for Research on Cancer and Aging, Department of Gastroenterology & Nutrition, Hôpital de l'Archet, Nice, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Hébuterne
authors.affiliation: Gastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine; D008727:Methotrexate
keywords: Crohn’s disease; Infliximab; adalimumab; anti-TNF monotherapy