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Second-line strategies after anti-TNF failure in chronically active, moderate-to-severe ulcerative colitis: a retrospective, multicentre cohort study
B. Farkas, JK. Limdi, P. Bacsur, EV. Savarino, L. Bertin, K. Sethi-Arora, P. Miheller, F. Vilmos, F. Castiglione, L. Bonacci, M. Lukas, N. Maharshak, G. Berman, Ž. Krznaric, P. Wetwittayakhlang, PL. Lakatos, JB. Seidelin, M. Attauabi, G....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, multicentrická studie, srovnávací studie
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- gastrointestinální látky * terapeutické užití aplikace a dávkování MeSH
- humanizované monoklonální protilátky terapeutické užití aplikace a dávkování MeSH
- kohortové studie MeSH
- kolektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- neúspěšná terapie MeSH
- piperidiny terapeutické užití aplikace a dávkování MeSH
- pyrimidiny terapeutické užití aplikace a dávkování MeSH
- pyrrolidiny terapeutické užití aplikace a dávkování MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- TNF-alfa * antagonisté a inhibitory MeSH
- ulcerózní kolitida * farmakoterapie chirurgie MeSH
- ustekinumab terapeutické užití aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
BACKGROUND: Many ulcerative colitis (UC) patients require the use of second-line agents after the failure of anti-TNF therapy. RESEARCH DESIGN AND METHODS: We conducted a multicenter, retrospective study including 683 chronically active, moderate-to-severe UC patients who failed first-line anti-TNFs. The rate of treatment persistence and colectomy-free survival was assessed up to 3 years after the initiation of second-line therapy. Predictors for colectomy and persistence were investigated. RESULTS: After the failure of the first-line anti-TNF, ustekinumab had superior persistence and colectomy-free survival rates compared to tofacitinib (p = 0.05; p = 0.001) and vedolizumab (p = 0.02; p = 0.05), but significant difference was only found in persistence rates in comparison with anti-TNFs (p < 0.001). Regardless of the number of prior anti-TNFs, significantly higher persistence (p = 0.05) and colectomy-free survival rates (p = 0.01) were observed over 2 years with ustekinumab than with vedolizumab or tofacitinib, whereas ustekinumab's superiority over tofacitinib seemed to disappear by the third year. Hypoalbuminaemia (p = 0.002) and shorter disease duration at second-line initiation (p = 0.03) increased, while concomitant immunomodulators (p = 0.05) reduced the risk for colectomy. Shorter disease duration (p = 0.01) and primary non-response to the previously used anti-TNF (p < 0.001) negatively influenced persistence with second-line non-TNF-targeted agents. CONCLUSION: After first-line anti-TNF failure, switching to a non-anti-TNF agent is worth considering in moderate-to-severe UC.
Center for Gastroenterology Department of Internal Medicine University of Szeged Szeged Hungary
Department of Biostatistics AdWare Research Balatonfüred Hungary
Department of Coloproctology Irkutsk Regional Hospital Irkutsk Russia
Department of Gastroenterology and Hepatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
Department of Internal Medicine and Oncology Semmelweis University Budapest Hungary
Department of Medical Sciences University of Turin Turin Italy
Department of Surgery Oncology and Gastroenterology University of Padua Padua Italy
Department of Surgery Transplantation and Gastroenterology Semmelweis University Budapest Hungary
Division of Gastroenterology McGill University Health Centre Montreal Quebec Canada
Gastroenterology Department General Hospital of Athens G Gennimatas Athens Greece
Gastroenterology Department Moscow Clinical Scientific Center named after A S Loginov Moscow Russia
Gastroenterology Department Zagreb School of Medicine Zagreb Croatia
Gastroenterology Unit Azienda Ospedale Università of Padua Padua Italy
Gastroenterology Unit Federal Scientific Center of Surgery and Traumatology Irkutsk Russia
Gastroenterology Unit Rho Hospital ASST Rhodense Milan Italy
HCEMM USZ Translational Colorectal Research Group Szeged Hungary
IBD Unit Northern Care Alliance NHS Foundation Trust Manchester UK
IBD Unit Research Institute of Health Organization and Medical Management Moscow Russia
Institute for Translational Medicine Medical School University of Pécs Pécs Hungary
Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
Citace poskytuje Crossref.org
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