Abstract
ABSTRACT Background: Anti-TNF drugs are a fundamental part of the treatment of Crohn’s disease (CD), so identifying factors related to loss of response is of great importance in clinical practice. Aim: Identify potential factors related to loss of response to anti-TNF agents in Crohn’s disease patients. Methods: This is a prospective study of CD patients attending a specialized outpatient clinic using a specific form, including patients with more than one year of follow-up on anti-TNF (Infliximab, Adalimumab or Certolizumab pegol). The information obtained was tabulated and analyzed to identify possible reasons for the loss of response to anti-TNF agents; results were submitted to statistical analysis by chi-square teste considering significant p<0.05. Results: Sixty-four patients were included, most of them females (56.3%), predominant age group between 26 and 55 years, of whom 25 required optimization, 23 remained in remission with the usual dose and interval, and 16 required switch; most of those who needed switch had hematological problems such as anemia and/or had already undergone surgical treatment for CD. Conclusions: Anemia and prior CD surgery have been linked to loss of anti-TNF response.
Highlights
The management of Crohn’s disease (CD) has been profoundly modified by the introduction of biological treatments, in particular by the availability of tumor necrosis factor-a (TNF-a) inhibitors
TNF-a inhibitors were highly effective in CD, reducing hospitalization and surgery rates[3,14]
Despite the availability of such effective agents, CD treatment often remains suboptimal and the disease remain partially uncontrolled[8]. Another important fact of anti-TNF therapy is that it allows mucosal healing to be maintained, which seems to be a good predictor for a decreased need for long-term surgery[8]
Summary
The management of Crohn’s disease (CD) has been profoundly modified by the introduction of biological treatments, in particular by the availability of tumor necrosis factor-a (TNF-a) inhibitors. Despite the availability of such effective agents, CD treatment often remains suboptimal and the disease remain partially uncontrolled[8] Another important fact of anti-TNF therapy is that it allows mucosal healing to be maintained, which seems to be a good predictor for a decreased need for long-term surgery[8]. There are available methods to evaluate possible causes of loss of anti-TNF response, but they are high cost, with little availability, making them unviable[17], especially in our country. This fact reinforces the need to identify clinical factors that may be useful in identifying patients who are most likely to fail or lose response. Considering that there are few agents available to treat a chronic, progressive and debilitating disease such as CD, identifying possible reasons for drug failure and adapting the available drugs to the profile of each patient is fundamental
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