Azathioprine discontinuation earlier than 6 months in Crohn's disease patients started on anti-TNF therapy is associated with loss of response and the need for anti-TNF dose escalation. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Viazis, Nikos; Koukouratos, Theodoros; Anastasiou, Jiannis; Giakoumis, Marios; Triantos, Christos; Tsolias, Chrisostomos; Theocharis, Georgios; Karamanolis, Dimitrios G.
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 4(2015:Apr.)
• Publication Date: 2015-04
• Subjects: antitumor necrosis factor therapy -- azathioprine coadministration -- Crohn's disease -- ulcerative colitis; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000303
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objectives: A high proportion of Crohn's disease (CD) patients lose response to antitumor necrosis factor (anti-TNF) and therapy needs to be intensified. We aimed to prospectively determine the predictors and frequency of anti-TNF loss of response and therefore the need for dose escalation and de-escalation in CD patients treated with infliximab or adalimumab. Methods: All patients were anti-TNF naive while concomitant azathioprine was administered for 6 months. In patients initially responding to anti-TNF and subsequently losing clinical response after the first 14 weeks of therapy, dose escalation was scheduled. During the follow-up period and after 1 year of intensified administration, anti-TNF was de-escalated in patients in remission. Results: A total of 161 patients were started on infliximab ( n =96) or adalimumab ( n =65); however, 29 patients (18.0%) did not respond to therapy and were excluded from further analysis. From the remaining 132 patients (infliximab=77, adalimumab=55), 31 (23.5%) needed a dose escalation for maintenance of remission during a median 28-month follow-up period. Factors associated with loss of response and therefore the need for anti-TNF dose escalation were azathioprine discontinuation earlier than 6 months and smoking. Most patients achieved clinical remission ( n =25, 80.6%) without other interventions and among these, 16 patients (64%) were successfully de-escalated to the standard maintenance infliximab or adalimumab dose schedule after 1 year of intensified anti-TNF administration. Conclusion: Azathioprine discontinuation earlier than 6 months and smoking in CD patients started on anti-TNF therapy is associated with loss of response and the need for anti-TNF dose escalation.