Immunomodulator use does not prevent first loss of response to anti-tumour necrosis factor alpha therapy in inflammatory bowel disease: long-term outcomes in a real-world cohort

Poornima Varma, Anton Rajadurai, Darcy Quinn Holt, David A Devonshire, Chris Desmond, Michael P. Swan, Debra Nathan, Edward Shelton, Lani Prideaux, Catherine Sorrell, Ferry Rusli, Luke RF Crantock, Anouk Dev, Dilip Ratnam, Stephen Pianko, Gregory Moore

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim: To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Methods: A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Results: Two hundred and twenty-four patients were identified; 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion: In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.

Original languageEnglish
Pages (from-to)753-760
Number of pages8
JournalInternal Medicine Journal
Volume49
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • anti-TNF therapy
  • combination therapy
  • inflammatory bowel disease
  • loss of response
  • monotherapy

Cite this

Varma, Poornima ; Rajadurai, Anton ; Holt, Darcy Quinn ; Devonshire, David A ; Desmond, Chris ; Swan, Michael P. ; Nathan, Debra ; Shelton, Edward ; Prideaux, Lani ; Sorrell, Catherine ; Rusli, Ferry ; Crantock, Luke RF ; Dev, Anouk ; Ratnam, Dilip ; Pianko, Stephen ; Moore, Gregory. / Immunomodulator use does not prevent first loss of response to anti-tumour necrosis factor alpha therapy in inflammatory bowel disease : long-term outcomes in a real-world cohort. In: Internal Medicine Journal. 2019 ; Vol. 49, No. 6. pp. 753-760.
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abstract = "Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim: To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Methods: A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Results: Two hundred and twenty-four patients were identified; 139 (62.1{\%}) on combination therapy and 85 (37.9{\%}) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4{\%} on combination therapy and 40.6{\%} on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion: In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.",
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Immunomodulator use does not prevent first loss of response to anti-tumour necrosis factor alpha therapy in inflammatory bowel disease : long-term outcomes in a real-world cohort. / Varma, Poornima; Rajadurai, Anton; Holt, Darcy Quinn; Devonshire, David A; Desmond, Chris; Swan, Michael P.; Nathan, Debra ; Shelton, Edward; Prideaux, Lani; Sorrell, Catherine ; Rusli, Ferry; Crantock, Luke RF ; Dev, Anouk; Ratnam, Dilip; Pianko, Stephen; Moore, Gregory.

In: Internal Medicine Journal, Vol. 49, No. 6, 01.06.2019, p. 753-760.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Rajadurai, Anton

AU - Holt, Darcy Quinn

AU - Devonshire, David A

AU - Desmond, Chris

AU - Swan, Michael P.

AU - Nathan, Debra

AU - Shelton, Edward

AU - Prideaux, Lani

AU - Sorrell, Catherine

AU - Rusli, Ferry

AU - Crantock, Luke RF

AU - Dev, Anouk

AU - Ratnam, Dilip

AU - Pianko, Stephen

AU - Moore, Gregory

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N2 - Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim: To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Methods: A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Results: Two hundred and twenty-four patients were identified; 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion: In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.

AB - Background: Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim: To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Methods: A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Results: Two hundred and twenty-four patients were identified; 139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years; 59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups; 1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion: In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.

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