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 18 December 2017

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News

Factors associated with discontinuation of anti-TNF inhibitors in IBD 

The most recent issue of Inflammatory Bowel Diseases assessed rates of completion of anti-TNF induction, duration of continued use, intraclass substitution, and dose adjustments.

News image

Antitumor necrosis factor (anti-TNF) medications are known to be highly efficacious in persons with moderate-to-severe inflammatory bowel disease (IBD). 

There is a paucity of data from population-based sources to elucidate persistence with these medications in the general population of IBD. 

Discontinuation of anti-TNF therapy is a marker of lack of effectiveness, intolerance, and patient/physician practice preferences.

Dr Laura Targownik and colleagues identified all persons with IBD in Manitoba who were dispensed infliximab, and adalimumab between 2001 and 2014. 

Subjects were followed longitudinally to assess rates of completion of anti-TNF induction, duration of continued use, intraclass substitution, and dose adjustments. 

11% with IBD were prescribed an anti-TNF drug
Inflammatory Bowel Diseases
Cox proportional hazards models were used to test demographic and clinical factors associated with anti-TNF therapy discontinuation.

Overall, the researchers noted that 11% with IBD were prescribed an anti-TNF drug. 

Approximately four-fifths of persons starting on anti-TNF therapy completed induction. 

At 1 and 5 years, the team noted that persistence rates with the original anti-TNF were approximately 60% and 40%, respectively. 

Immunomodulator use at the time of anti-TNF dispensation was associated with a decreased likelihood of anti-TNF discontinuation in both Crohn's disease and ulcerative colitis. 

The researchers observed that adalimumab users with Crohn's disease who reached maintenance phase had a higher risk of discontinuation than infliximab users.

Dr Targownik's team concludes, "Approximately two-fifths of anti-TNF users discontinue use within 1 year of initiation, and three-fifths will have discontinued at 5 years."

"Concomitant IM therapy has a modest effect on discontinuation rates."

Inflamm Bowel Dis 2017: 23(3): 409-420
17 March 2017

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