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Anti-TNF-associated immunogenicity: use a retroactive drug but a proactive approach
  1. Ashish Srinivasan1,2,3,
  2. Peter De Cruz1,4,
  3. Daniel R van Langenberg2,3
  1. 1Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
  2. 2Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
  3. 3Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
  4. 4Austin Academic Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Ashish Srinivasan, Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; ashish.srinivasan{at}monash.edu

https://doi.org/10.1136/gutjnl-2020-322302

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    We read the study by Roblin et al with interest.1 Given that prior antitumour necrosis factor (anti-TNF) monotherapy failure is frequently associated with antibody development to a second anti-TNF within 24 months,2 it is our practice, to (re)introduce immunomodulator cotherapy with the second anti-TNF to reduce immunogenicity and improve treatment persistence.3 4 Roblin et al’s findings support this concept, reinforcing the value of thiopurine cotherapy to reduce immunogenicity with the second anti-TNF following immune-mediated failure of first-line anti-TNF monotherapy. Moreover, they demonstrated that combination therapy was less frequently associated with clinical relapse, clinical failure and pharmacokinetic failure (ie, undetectable anti-TNF trough levels with high antidrug antibodies) than anti-TNF monotherapy. These data also imply a longer (24 months) duration of combination therapy may be required for those at increased risk of immunogenicity than previously (6–12 months) suggested.5 In retrospect, perhaps continuing combination therapy ab initio, particularly for infliximab where combination …

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    • Contributors AS, PDC and DRVL: manuscript preparation and review. All of the authors approved the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AS has received educational support from Pfizer. PDC has served as a consultant, an advisory board member or a speaker for AbbVie, Baxter, Ferring, Janssen, Shire and Takeda, and received research support from Ferring, Shire, Janssen, AbbVie and Takeda. DRVL has received educational grants or research support from Pfizer, Takeda, Ferring, Shire and has received consultancy and/or speaker’s fees from Pfizer, Janssen, Abbvie, Ferring, Vifor and Emerge Health.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.