Introduction A common therapeutic strategy in events of failure of the first-line anti-TNFα biologic in Crohn’s Disease (CD) is to switch to another biologic agent from the same class. There is a significant body of evidence to support using adalimumab (ADA) as second-line therapy following infliximab (IFX) intolerance or loss of response. The aim of this study is to provide evidence around the use of IFX as second-line therapy in CD, an empirical strategy gaining popularity since both agents have recently been licensed as first line agents for moderate-to-severe CD.
Methods Inflammatory Bowel Disease (IBD) specialists from 5 hospitals were invited to contribute all suitable cases through a secure online questionnaire. Data was gathered on patient demographics, disease extent and behaviour, prior or concurrent therapies, duration and outcome of ADA and IFX therapy and reason for switching. Response to the biologic was determined using Physician’s Global Assessment (PGA) by each IBD specialist.
Results Data on 28 patients (10 male) were gathered. Median duration of disease before starting biologics was 4.5years.
Of the 19 patients on ongoing IFX, 5/19 (26%) are on monotherapy 11/19 (58%) are on concurrent immunomodulator 2/19 (11%)on concurrent mesalasine and 1/19(5%) are on concurrent steroids.
3 people discontinued IFX following an initial response due to hypersensitivity reaction (2/3) and due to conversion back to ADA due to patient preference (1/3).
Conclusion Using ADA as first-line and IFX second-line for ADA failures is a successful and safe strategy in patients with moderate-to-severe CD.
Reference Sandborn WJ. Ann Intern Med. Jun 19;2007;146(12):829–38
Disclosure of Interest E. Russo Grant/research support from: GSK, R. Hackett: None Declared, S. Campbell Grant/research support from: MSD. Abbvie, J. Lindsay Grant/research support from: MSD, Abbvie, Consultant for: MSD, Abbvie, Tadeka, P. Irving Consultant for: Abbvie, MSD, T. Orchard Grant/research support from: Johnson and Johnson, Consultant for: Abbvie, Ferring, MSD, Takeda, Vifor, Warner Chilcott.
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