Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?

Background: About a third of patients with inflammatory bowel disease do not respond to anti-tumour necrosis factor (anti-TNF) therapy, which is challenging. Aim: To review the current data on the two main strategies when facing primary non-response to an anti-TNF agent in inflammatory bowel disease...

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Autores principales:	Javier P. Gisbert, María Chaparro
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	anti-TNF inflammatory bowel disease primary failure ustekinumab vedolizumab Medicine R
Acceso en línea:	https://doaj.org/article/ae22f2dd12284d1cb595702d40cc02e2
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spelling	oai:doaj.org-article:ae22f2dd12284d1cb595702d40cc02e22021-11-25T18:01:38ZPrimary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?10.3390/jcm102253182077-0383https://doaj.org/article/ae22f2dd12284d1cb595702d40cc02e22021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5318https://doaj.org/toc/2077-0383Background: About a third of patients with inflammatory bowel disease do not respond to anti-tumour necrosis factor (anti-TNF) therapy, which is challenging. Aim: To review the current data on the two main strategies when facing primary non-response to an anti-TNF agent in inflammatory bowel disease: changing to a second anti-TNF (switching) or to a drug with another mechanisms of action (swapping). Methods: We performed a bibliographic search to identify studies reporting on efficacy of any biologic treatment after primary anti-TNF non-response. Results: The efficacy of a second anti-TNF is lower when the reason to withdraw the first one is primary failure. Nevertheless, switching to another anti-TNF even after primary failure may still be effective in some patients. Both vedolizumab and ustekinumab have generally been shown to be less effective in anti-TNF exposed patients. However, despite primary anti-TNF failure, patients may respond to vedolizumab or ustekinumab in a limited but considerable number of cases. The cause for swapping (primary vs. secondary anti-TNF failure) seems to have limited effect on vedolizumab efficacy. Primary anti-TNF non-response seems to be a clearer predictor of treatment failure for ustekinumab. Unfortunately, the two main strategies to treat specifically a patient with primary non-response to an anti-TNF agent—switching to a second anti-TNF or swapping for vedolizumab/ustekinumab—have not been properly compared. Conclusion: The data reviewed in the present study clearly emphasise the imperative need to carry out head-to-head randomised trials in patients exposed to anti-TNF agents in general, and specifically in those with primary non-response to these agents.Javier P. GisbertMaría ChaparroMDPI AGarticleanti-TNFinflammatory bowel diseaseprimary failureustekinumabvedolizumabMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5318, p 5318 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anti-TNF inflammatory bowel disease primary failure ustekinumab vedolizumab Medicine R
spellingShingle	anti-TNF inflammatory bowel disease primary failure ustekinumab vedolizumab Medicine R Javier P. Gisbert María Chaparro Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
description	Background: About a third of patients with inflammatory bowel disease do not respond to anti-tumour necrosis factor (anti-TNF) therapy, which is challenging. Aim: To review the current data on the two main strategies when facing primary non-response to an anti-TNF agent in inflammatory bowel disease: changing to a second anti-TNF (switching) or to a drug with another mechanisms of action (swapping). Methods: We performed a bibliographic search to identify studies reporting on efficacy of any biologic treatment after primary anti-TNF non-response. Results: The efficacy of a second anti-TNF is lower when the reason to withdraw the first one is primary failure. Nevertheless, switching to another anti-TNF even after primary failure may still be effective in some patients. Both vedolizumab and ustekinumab have generally been shown to be less effective in anti-TNF exposed patients. However, despite primary anti-TNF failure, patients may respond to vedolizumab or ustekinumab in a limited but considerable number of cases. The cause for swapping (primary vs. secondary anti-TNF failure) seems to have limited effect on vedolizumab efficacy. Primary anti-TNF non-response seems to be a clearer predictor of treatment failure for ustekinumab. Unfortunately, the two main strategies to treat specifically a patient with primary non-response to an anti-TNF agent—switching to a second anti-TNF or swapping for vedolizumab/ustekinumab—have not been properly compared. Conclusion: The data reviewed in the present study clearly emphasise the imperative need to carry out head-to-head randomised trials in patients exposed to anti-TNF agents in general, and specifically in those with primary non-response to these agents.
format	article
author	Javier P. Gisbert María Chaparro
author_facet	Javier P. Gisbert María Chaparro
author_sort	Javier P. Gisbert
title	Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
title_short	Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
title_full	Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
title_fullStr	Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
title_full_unstemmed	Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?
title_sort	primary failure to an anti-tnf agent in inflammatory bowel disease: switch (to a second anti-tnf agent) or swap (for another mechanism of action)?
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/ae22f2dd12284d1cb595702d40cc02e2
work_keys_str_mv	AT javierpgisbert primaryfailuretoanantitnfagentininflammatoryboweldiseaseswitchtoasecondantitnfagentorswapforanothermechanismofaction AT mariachaparro primaryfailuretoanantitnfagentininflammatoryboweldiseaseswitchtoasecondantitnfagentorswapforanothermechanismofaction
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Primary Failure to an Anti-TNF Agent in Inflammatory Bowel Disease: Switch (to a Second Anti-TNF Agent) or Swap (for Another Mechanism of Action)?

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