Outcome of inflammatory bowel disease patients treated with TNF-α inhibitors: two-year follow-up.
BACKGROUND
Biological medications, particularly TNF-α inhibitors, are used increasingly for active inflammatory bowel disease (IBD). Even though they are superior to many older medications in achieving remission and mucosal healing, primary nonresponse and loss of response remain significant problems, and a remarkable proportion of patients still need surgery at some point.


OBJECTIVE
To study the outcome of IBD patients treated with TNF-α inhibitors, either infliximab or adalimumab, with a two-year follow-up.


METHODS
Patient data from the hospital electronic patient documents of IBD patients treated with TNF-α inhibitors were studied. The main targets of interest were treatment response, the remission rate and the number of patients operated, as well as reasons for the discontinuation of treatment. Remission was defined both endoscopically and by faecal calprotectin.


RESULTS
Altogether 100 patients were included. Only 29% of the patients achieved remission during the two-year follow-up. 26% of the Crohn's disease patients and 36% of the ulcerative colitis patients underwent surgery during the follow-up. A significant proportion of patients experienced side effects of the medication (21%) or discontinued the therapy for other reasons (altogether 63%).


CONCLUSIONS
In this single centre study of 100 IBD patients treated with TNF-α inhibitors, less than one-third of the patients achieved remission, and a significant proportion had side effects and needed surgery during the two-year follow-up. There is an obvious need for more effective therapies with less side effects for IBD patients.
a Department of Gastroenterology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland.
Erika
E
Lehtola
a Department of Gastroenterology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland.
Johanna
J
Haapamäki
a Department of Gastroenterology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland.
Martti A
MA
Färkkilä
D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005243:Feces / Q000737:chemistry; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
Adalimumab; Crohn’s disease; TNF-α inhibitor; inflammatory bowel disease; infliximab; surgery; ulcerative colitis