Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study
Abstract Background No study has performed a face-to-face comparison of biologics after the failure of the first anti-TNF agent in patients with Crohn’s disease (CD). The aim of the study was to compare the efficacy of biologics in this setting. Methods Patients with CD who were refractory to a firs...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-12-01
|
| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-022-02583-5 |
| _version_ | 1811190505944383488 |
|---|---|
| author | Rayer Cassandra Maria Nachury Bourreille Arnaud Roblin Xavier Peyrin-Biroulet Laurent Viennot Stephanie Flamant Mathurin Laharie David Caron Bénédicte Dewitte Marie Siproudhis Laurent Fumery Mathurin Bouguen Guillaume |
| author_facet | Rayer Cassandra Maria Nachury Bourreille Arnaud Roblin Xavier Peyrin-Biroulet Laurent Viennot Stephanie Flamant Mathurin Laharie David Caron Bénédicte Dewitte Marie Siproudhis Laurent Fumery Mathurin Bouguen Guillaume |
| author_sort | Rayer Cassandra |
| collection | DOAJ |
| description | Abstract Background No study has performed a face-to-face comparison of biologics after the failure of the first anti-TNF agent in patients with Crohn’s disease (CD). The aim of the study was to compare the efficacy of biologics in this setting. Methods Patients with CD who were refractory to a first anti-TNF agent, and treated with ustekinumab (UST), vedolizumab (VDZ), or a second anti-TNF drug as a second-line biological agent at 10 French tertiary centres from 2013 to 2019 were retrospectively included in this study. Results Among the 203 patients included, 90 (44%) received UST, 42 (21%) received VDZ and 71 (35%) received a second anti-TNF agent. The first anti-TNF agent was discontinued due to a primary nonresponse in 42 (21%) patients. At weeks 14–24, the rates of steroid-free remission were similar between the UST, VDZ and second anti-TNF groups (29%, 38% and 44%, respectively, p = 0.15). With a mean follow-up of 118 weeks, drug survival was shorter for patients who received ustekinumab treatment (p = 0.001). In the case of trough level less than 5 µg/ml, patients treated with a second anti-TNF agent had a higher postinduction remission rate (p = 0.002), and drug survival (p = 0.0005). No other relevant factors were associated with treatment efficacy, including trough levels greater than 5 µg/ml. Conclusions VDZ, UST and a second anti-TNF agent exhibit similar efficacy in the short term, as second-biological line treatment in patients with CD who are refractory to a first anti-TNF agent, but shorter drug maintenance is observed for patients treated with UST. |
| first_indexed | 2024-04-11T14:52:19Z |
| format | Article |
| id | doaj.art-f372eec863b14de49769f5777229cec8 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-04-11T14:52:19Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-f372eec863b14de49769f5777229cec82022-12-22T04:17:26ZengBMCBMC Gastroenterology1471-230X2022-12-012211910.1186/s12876-022-02583-5Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective studyRayer Cassandra0Maria Nachury1Bourreille Arnaud2Roblin Xavier3Peyrin-Biroulet Laurent4Viennot Stephanie5Flamant Mathurin6Laharie David7Caron Bénédicte8Dewitte Marie9Siproudhis Laurent10Fumery Mathurin11Bouguen Guillaume12CHU Rennes, University RennesCHU Lille, University of LilleCHU NantesCHU Saint-EtienneInserm U954 Deparment of Hepato-Gastroenterology, Department of Gastroenterology, Nancy University HospitalCHU CaenClinique Jules VernesCHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-Gastroentérologie Et Oncologie Digestive, Université de BordeauxInserm U954 Deparment of Hepato-Gastroenterology, Department of Gastroenterology, Nancy University HospitalCHU Rennes, University RennesCHU Rennes, University Rennes, INSERM, CIC1414, Institute NUMECAN (Nutrition Metabolism and Cancer)Service d’Hépato-Gastroentérologie Et Oncologie Digestive, CHU Amiens Et PeriTox, UMR I0-I, Université de PicardieCHU Rennes, University Rennes, INSERM, CIC1414, Institute NUMECAN (Nutrition Metabolism and Cancer)Abstract Background No study has performed a face-to-face comparison of biologics after the failure of the first anti-TNF agent in patients with Crohn’s disease (CD). The aim of the study was to compare the efficacy of biologics in this setting. Methods Patients with CD who were refractory to a first anti-TNF agent, and treated with ustekinumab (UST), vedolizumab (VDZ), or a second anti-TNF drug as a second-line biological agent at 10 French tertiary centres from 2013 to 2019 were retrospectively included in this study. Results Among the 203 patients included, 90 (44%) received UST, 42 (21%) received VDZ and 71 (35%) received a second anti-TNF agent. The first anti-TNF agent was discontinued due to a primary nonresponse in 42 (21%) patients. At weeks 14–24, the rates of steroid-free remission were similar between the UST, VDZ and second anti-TNF groups (29%, 38% and 44%, respectively, p = 0.15). With a mean follow-up of 118 weeks, drug survival was shorter for patients who received ustekinumab treatment (p = 0.001). In the case of trough level less than 5 µg/ml, patients treated with a second anti-TNF agent had a higher postinduction remission rate (p = 0.002), and drug survival (p = 0.0005). No other relevant factors were associated with treatment efficacy, including trough levels greater than 5 µg/ml. Conclusions VDZ, UST and a second anti-TNF agent exhibit similar efficacy in the short term, as second-biological line treatment in patients with CD who are refractory to a first anti-TNF agent, but shorter drug maintenance is observed for patients treated with UST.https://doi.org/10.1186/s12876-022-02583-5Crohn’s diseaseAnti-TNFVedolizumabUstekinumabTreatment strategySecond line |
| spellingShingle | Rayer Cassandra Maria Nachury Bourreille Arnaud Roblin Xavier Peyrin-Biroulet Laurent Viennot Stephanie Flamant Mathurin Laharie David Caron Bénédicte Dewitte Marie Siproudhis Laurent Fumery Mathurin Bouguen Guillaume Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study BMC Gastroenterology Crohn’s disease Anti-TNF Vedolizumab Ustekinumab Treatment strategy Second line |
| title | Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study |
| title_full | Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study |
| title_fullStr | Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study |
| title_full_unstemmed | Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study |
| title_short | Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn’s disease: a multicentre retrospective study |
| title_sort | efficacy of ustekinumab vedolizumab or a second anti tnf agent after the failure of a first anti tnf agent in patients with crohn s disease a multicentre retrospective study |
| topic | Crohn’s disease Anti-TNF Vedolizumab Ustekinumab Treatment strategy Second line |
| url | https://doi.org/10.1186/s12876-022-02583-5 |
| work_keys_str_mv | AT rayercassandra efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT marianachury efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT bourreillearnaud efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT roblinxavier efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT peyrinbirouletlaurent efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT viennotstephanie efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT flamantmathurin efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT lahariedavid efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT caronbenedicte efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT dewittemarie efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT siproudhislaurent efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT fumerymathurin efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy AT bouguenguillaume efficacyofustekinumabvedolizumaborasecondantitnfagentafterthefailureofafirstantitnfagentinpatientswithcrohnsdiseaseamulticentreretrospectivestudy |