scholarly journals A Novel Radiomics Nomogram for the Prediction of Secondary Loss of Response to Infliximab in Crohn’s Disease

2021 ◽  
Vol Volume 14 ◽  
pp. 2731-2740
Author(s):  
Yueying Chen ◽  
Hanyang Li ◽  
Jing Feng ◽  
Shiteng Suo ◽  
Qi Feng ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Secondary Loss ◽  
Loss Of Response

Swapping Versus Dose Optimization in Patients Losing Response to Adalimumab With Adequate Drug Levels

2021 ◽  
Author(s):  
Xavier Roblin ◽  
Capucine Genin ◽  
Stéphane Nancey ◽  
Nicolas Williet ◽  
Pauline Veyrard ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Therapy ◽  
Group Treatment ◽  
Treatment Discontinuation ◽  
Dose Optimization ◽  
Secondary Loss ◽  
Loss Of Response ◽  
Trough Levels

Abstract Background In cases of loss of response due to mechanistic failure under antitumor necrosis factor agents, it is recommended to switch to another class of biologics. Two different strategies were compared in patients with inflammatory bowel disease (IBD) who were treated with nonoptimized adalimumab (ADA) and experienced a loss of response despite therapeutic trough levels of adalimuma—either ADA dose optimization or switching to vedolizumab or ustekinumab. Methods Patients under maintenance therapy with ADA monotherapy (40 mg every 14 days) and who experienced a secondary loss of response with trough levels > 4.9 μg/mL were included prospectively in this nonrandomized study. The primary end point was the survival rate without therapeutic discontinuation after ADA dose optimization or switching to another class of biologics. Results Adalimumab was optimized (n = 61 patients, 42 Crohn’s disease, 19 ulcerative colitis) or swapped for vedolizumab (n = 40, 20 ulcerative colitis) or ustekinumab (n = 30, 30 Crohn’s disease). At 24 months, 11 out of 70 patients (14.8%) in the swap group discontinued treatment compared with 36 out of 61 (59.6%) patients in the optimization group (P < 0.001). The median time without therapeutic discontinuation was significantly longer in the swap group (>24 months) than in the optimization group (13.3 months, P < 0.001). In the optimization group, treatment discontinuation was positively associated with baseline fecal calprotectin >500 μg/g (HR, 3.53; 95% CI, 1.16–10.72; P = 0.026) and inversely associated with variation of trough levels of adalimumab (>2 µg/mL from baseline to week 8 after optimization; HR, 0.51; 95% CI, 0.13–0.82; P = 0.03). In the swap group, no factor was associated with treatment discontinuation. Conclusion In IBD patients under ADA maintenance therapy who experience a secondary loss of response and in whom trough levels are >4.9µg/mL, swapping to another class is better than optimizing ADA, which is, however, appropriate in a subgroup of patients.

Re-induction with intravenous Ustekinumab after secondary loss of response is a valid optimization strategy in Crohn’s disease

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sebastiaan ten Bokkel Huinink ◽  
Vince Biemans ◽  
Marjolijn Duijvestein ◽  
Marieke Pierik ◽  
Frank Hoentjen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Optimization Strategy ◽  
Secondary Loss ◽  
Loss Of Response

scholarly journals Anti-TNF Re-induction Is as Effective, Simpler, and Cheaper Compared With Dose Interval Shortening for Secondary Loss of Response in Crohn’s Disease

2017 ◽  
Vol 12 (3) ◽  
pp. 280-288 ◽  
Author(s):  
Ashish Srinivasan ◽  
Abhinav Vasudevan ◽  
Anne McFarlane ◽  
Miles P Sparrow ◽  
Peter R Gibson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Dose Interval ◽  
Secondary Loss ◽  
Loss Of Response
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