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

Clinical and Research Centre for Inflammatory Bowel Diseases ISCARE IVF Clinical Center Českomoravská Prague Czech Republic

Department of Biostatistics AdWare Research Balatonfüred Hungary

Department of Coloproctology Irkutsk Regional Hospital Irkutsk Russia

Department of Gastroenterology and Hepatology Copenhagen University Hospital Herlev and Gentofte Herlev Denmark

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 Internal Medicine Clinical Unit of Clinical Nutrition University Hospital Zagreb Zagreb Croatia

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 1st Department of Medicine Medical School University of Pécs Pécs Hungary

Division of Gastroenterology McGill University Health Centre Montreal Quebec Canada

Gastroenterology and Hepatology Unit Division of Internal Medicine Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand

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 of Clinical Medicine and Surgery University of Naples Federico 2 Naples Italy

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 MOM Unit Digestive Diseases Institute Shaare Zedek Medical Center Affiliated with the Medical School Hebrew University Jerusalem Israel

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

References provided by Crossref.org