Impact of Prior Biologic Mechanism of Action on Anti‐
TNF
Effectiveness in Inflammatory Bowel Disease: An
ENEIDA
Registry Study
Carmen Yagüe Caballero, Santiago García López, Ana Royo Esteban, Laura Figueras Panillo, Pilar Nos, Luisa de Castro, M. Dolores Martín‐Arranz, Manuel Barreiro‐de Acosta, Elena Ricart, Ruth de Francisco, Eva Iglesias, Antonio Giordano, Pilar Varela, Iago Rodríguez‐Lago, Montserrat Rivero, Beatriz Sicilia, Merce Navarro‐Llavat, Isabel Vera, Carles Suria, Jordi Guardiola, Jesús Barrio, Margalida Calafat, Ana Gutiérrez, Xavier Calvet, David Rafael de la Cruz, Francisco Mesonero, Cristina Martínez Pascual, Javier P. Gisbert, Carla J. Gargallo‐Puyuelo, David Monfort i Miquel, Mónica Sierra, Laura Arranz, Cristina Rodríguez‐Gutiérrez, Rufo Lorente, Fernando Bermejo, Lucía Márquez‐Mosquera, Gisela Torres Vicente, José Lázaro Pérez‐Calle, José M. Huguet, Laura Ramos, Ángel Ponferrada‐Díaz, Daniel Ceballos, Mª. Teresa Diz‐Lois Palomares, Eva Sesé Abizanda, Pablo Vega, Ramón Pajares, Javier Santos Fernández, Elena Betoré, David Busquets, Olga Merino, Carlos Martínez‐Flores, Yamile Zabana, Manuela Josefa Sampedro González, Jone Ortiz de Zarate, Ana Fuentes Coronel, Empar Sainz Arnau, Daniel Carpio, Nuria Jiménez, Ignacio Marín‐Jiménez, Luis Bujanda, Raquel Camargo Camero, Martín Irabien, María Abanades Tercero, Benito Velayos Jiménez, Pilar Robledo Andres, Ana María Trapero, Pedro G. Delgado‐Guillena, Luís Hernández Villalba, Margarita Menacho, Nuria Rull Murillo, Carles Leal, Cristina Alba, Rosa Gómez Espín, Alfredo J. Lucendo, Manuel Van Domselaar, Laura García Alles, Eduardo Iyo Miyashiro, Ana Crespo Catalá, Pau Gilabert, Daniel Martín Rodríguez, Víctor Manuel Navas‐López, María Calvo Iñiguez, Daniel Ginard, Teresa Martínez Pérez, Eugeni Domènech, Diego Casas Deza ABSTRACT
Background
The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti‐TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti‐TNF treatment in this scenario.
Methods
Multicentre study based on data from the ENEIDA registry. Patients who received second‐line anti‐TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second‐line anti‐TNF after another anti‐TNF and patients receiving first‐line anti‐TNF therapy. Treatment durability and short‐ and long‐term clinical effectiveness were assessed.
Results
Sixty‐six Crohn's disease patients and 117 UC patients receiving anti‐TNF after other MOA were included. In CD, second‐line anti‐TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first‐line anti‐TNF therapy (HR 1.55; 95% CI, 1.05–2.30), without significant differences in short‐ or long‐term clinical effectiveness. In UC, anti‐TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first‐line anti‐TNF therapy (HR 1.69; 95% CI, 1.31–2.19) and with anti‐TNF after another anti‐TNF agent (HR 1.91; 95% CI, 1.48–2.48), its remission rates significantly lower at both short‐ and long‐term follow‐up ( p < 0.001).
Conclusions
Anti‐TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first‐line therapy or after another anti‐TNF agent, especially in UC.