title: Effectiveness of anti-TNFα drugs in patients with Crohn's disease who do not achieve remission with their first anti-TNFα agent.
abstract: BACKGROUND
  Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs.
  
  
  OBJECTIVE
  To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability.
  
  
  METHODS
  Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy.
  
  
  RESULTS
  In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR=0.3, 95% CI=0.1-0.7, P=0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively.
  
  
  CONCLUSIONS
  Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.
authors.affiliation: Department of Gastroenterology, La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Electronic address: mc.r.grau@gmail.com.
authors.forename: María Del Carmen
authors.initials: Mdel C
authors.lastname: R-Grau
authors.affiliation: Department of Gastroenterology, La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.affiliation: Department of Gastroenterology, Ramón y Cajal, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mesonero
authors.affiliation: Department of Gastroenterology, Clínico de Santiago, Santiago de Compostela, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.affiliation: Department of Gastroenterology, Virgen Macarena, Sevilla, Spain.
authors.forename: Luisa
authors.initials: L
authors.lastname: Castro
authors.affiliation: Department of Gastroenterology, Valme, CIBEREHD, Sevilla, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castro
authors.affiliation: Department of Gastroenterology, Germans Trias i Pujol, CIBEREHD, Badalona, Spain.
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.affiliation: Department of Gastroenterology, Infanta Sofía, Madrid, Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Mancenido
authors.affiliation: Department of Gastroenterology, Fundación Alcorcón, Madrid, Spain.
authors.forename: José Lázaro
authors.initials: JL
authors.lastname: Pérez-Calle
authors.affiliation: Department of Gastroenterology, Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Taxonera
authors.affiliation: Department of Gastroenterology, Río Hortega, Valladolid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Barrio
authors.affiliation: Department of Gastroenterology, Central de Asturias, Oviedo, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: De Francisco
authors.affiliation: Department of Gastroenterology, Complejo Hospitalario Universitario, Pontevedra, Spain.
authors.forename: Estela
authors.initials: E
authors.lastname: Fernández-Salgado
authors.affiliation: Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Luzón
authors.affiliation: Department of Gastroenterology, Cruces, Vizcaya, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Merino
authors.affiliation: Department of Gastroenterology, Manises, Valencia, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Oltra
authors.affiliation: Department of Gastroenterology, Cabueñes, Gijón, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Saro
authors.affiliation: Department of Gastroenterology, Fuenlabrada, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
authors.affiliation: Department of Gastroenterology, Reina Sofía, Maimónides Institute of Biomedical Research of Córdoba, Córdoba, Spain.
authors.forename: Valle
authors.initials: V
authors.lastname: García-Sánchez
authors.affiliation: Department of Gastroenterology, Son Espases, Mallorca, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ginard
authors.affiliation: Department of Gastroenterology, General de Alicante, Alicante, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Department of Gastroenterology, Puerta de Hierro, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vera
authors.affiliation: Department of Gastroenterology, Clínico de Valencia, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Antón
authors.affiliation: Department of Gastroenterology, Clínico Universitario Lozano Blesa, CIBEREHD, Zaragoza, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Ber
authors.affiliation: Department of Gastroenterology, Parc Tauli, CIBEREHD, Sabadell, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Department of Gastroenterology, La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D013030:Spain; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn's disease; Primary failure; Primary non-responder