Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease
Background/Aims Combination therapy with immunomodulators (IMMs) was proposed as a strategy to prevent the development of loss of response (LOR) to anti-tumor necrosis factor (TNF) for patients with inflammatory bowel disease (IBD). However, the effect is unclear in patients already exposed to IMMs....
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| Format: | Article |
| Language: | English |
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The Korean Association of Internal Medicine
2021-03-01
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| Series: | The Korean Journal of Internal Medicine |
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| Online Access: | http://www.kjim.org/upload/pdf/kjim-2019-279.pdf |
| _version_ | 1818443997824155648 |
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| author | Seung Wook Hong Jaewoo Park Hyuk Yoon Hye Ran Yang Cheol Min Shin Young Soo Park Nayoung Kim Dong Ho Lee Joo Sung Kim |
| author_facet | Seung Wook Hong Jaewoo Park Hyuk Yoon Hye Ran Yang Cheol Min Shin Young Soo Park Nayoung Kim Dong Ho Lee Joo Sung Kim |
| author_sort | Seung Wook Hong |
| collection | DOAJ |
| description | Background/Aims Combination therapy with immunomodulators (IMMs) was proposed as a strategy to prevent the development of loss of response (LOR) to anti-tumor necrosis factor (TNF) for patients with inflammatory bowel disease (IBD). However, the effect is unclear in patients already exposed to IMMs. The aim of this study was to evaluate whether combination therapy with IMMs is superior to monotherapy for prevention of LOR to anti-TNF. Methods This was a retrospective study of patients in Seoul National University Bundang Hospital with IBD between January 2009 and October 2018. LOR was defined as clinical deterioration after maintenance of anti-TNF for at least 6 months. We investigated the difference in incidence of LOR to anti-TNF between the monotherapy and combination groups. We additionally assessed factors affecting LOR development to anti-TNF. Results A total of 116 patients with IBD were included in this study (monotherapy 61 patients; combination 55 patients). Overall, LOR to anti-TNF occurred in 31 patients during the follow-up period. The combination of an anti-TNF agent and IMM showed no significant difference in the incidence of LOR compared to anti-TNF agent monotherapy (hazard ratio [HR], 1.64; 95% confidence interval [CI], 0.786 to 3.148; p = 0.182). Female sex was significantly associated with the development of LOR to anti-TNF (HR, 3.032; 95% CI, 1.467 to 6.268; p = 0.003). Conclusions Anti-TNF and IMM combination therapy did not prove efficacious in preventing the development of LOR in IBD patients. Female sex was associated with the development of LOR to anti-TNF; further studies are required to confirm these results. |
| first_indexed | 2024-12-14T19:08:56Z |
| format | Article |
| id | doaj.art-559d1bd0f4bb404c86cae0ce3fea08df |
| institution | Directory Open Access Journal |
| issn | 1226-3303 2005-6648 |
| language | English |
| last_indexed | 2024-12-14T19:08:56Z |
| publishDate | 2021-03-01 |
| publisher | The Korean Association of Internal Medicine |
| record_format | Article |
| series | The Korean Journal of Internal Medicine |
| spelling | doaj.art-559d1bd0f4bb404c86cae0ce3fea08df2022-12-21T22:50:46ZengThe Korean Association of Internal MedicineThe Korean Journal of Internal Medicine1226-33032005-66482021-03-0136Suppl 1S9S1710.3904/kjim.2019.279170405Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel diseaseSeung Wook Hong0Jaewoo Park1Hyuk Yoon2Hye Ran Yang3Cheol Min Shin4Young Soo Park5Nayoung Kim6Dong Ho Lee7Joo Sung Kim8 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, KoreaBackground/Aims Combination therapy with immunomodulators (IMMs) was proposed as a strategy to prevent the development of loss of response (LOR) to anti-tumor necrosis factor (TNF) for patients with inflammatory bowel disease (IBD). However, the effect is unclear in patients already exposed to IMMs. The aim of this study was to evaluate whether combination therapy with IMMs is superior to monotherapy for prevention of LOR to anti-TNF. Methods This was a retrospective study of patients in Seoul National University Bundang Hospital with IBD between January 2009 and October 2018. LOR was defined as clinical deterioration after maintenance of anti-TNF for at least 6 months. We investigated the difference in incidence of LOR to anti-TNF between the monotherapy and combination groups. We additionally assessed factors affecting LOR development to anti-TNF. Results A total of 116 patients with IBD were included in this study (monotherapy 61 patients; combination 55 patients). Overall, LOR to anti-TNF occurred in 31 patients during the follow-up period. The combination of an anti-TNF agent and IMM showed no significant difference in the incidence of LOR compared to anti-TNF agent monotherapy (hazard ratio [HR], 1.64; 95% confidence interval [CI], 0.786 to 3.148; p = 0.182). Female sex was significantly associated with the development of LOR to anti-TNF (HR, 3.032; 95% CI, 1.467 to 6.268; p = 0.003). Conclusions Anti-TNF and IMM combination therapy did not prove efficacious in preventing the development of LOR in IBD patients. Female sex was associated with the development of LOR to anti-TNF; further studies are required to confirm these results.http://www.kjim.org/upload/pdf/kjim-2019-279.pdfcolitis, ulcerativecrohn diseaseinf liximabimmunosuppressive agentsinflammatory bowel diseases |
| spellingShingle | Seung Wook Hong Jaewoo Park Hyuk Yoon Hye Ran Yang Cheol Min Shin Young Soo Park Nayoung Kim Dong Ho Lee Joo Sung Kim Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease The Korean Journal of Internal Medicine colitis, ulcerative crohn disease inf liximab immunosuppressive agents inflammatory bowel diseases |
| title | Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| title_full | Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| title_fullStr | Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| title_full_unstemmed | Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| title_short | Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| title_sort | comparison of loss of response between anti tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease |
| topic | colitis, ulcerative crohn disease inf liximab immunosuppressive agents inflammatory bowel diseases |
| url | http://www.kjim.org/upload/pdf/kjim-2019-279.pdf |
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