Prevalence of anti-TNF contraindications in Crohn's disease: A cross-sectional survey from the GETAID. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Amiot, Aurelien; Seksik, Philippe; Reimund, Jean-Marie; Nachury, Maria; Altwegg, Romain; Bourreille, Arnaud; Viennot, Stephanie; Fumery, Mathurin; Roblin, Xavier; Serrero, Melanie; Allez, Matthieu; Painchart, Claire; Chanteloup, Elise; Vuitton, Lucine; Fotsing, Ginette; Buisson, Anthony; Coulibaly, Baya; Nancey, Stephane; Gilletta, Cyrielle; Plastaras, Laurianne; Abitbol, Vered; Guillo, Lucas; Simon, Marion; Nahon, Stephane; Laharie, David; Peyrin-Biroulet, Laurent; Bouguen, Guillaume; Amiot, Aurelien; Gagniere, Charlotte; Nachury, Maria; Wils, Pauline; Bouhnik, Yoram; Stefanescu, Carmen; Treton, Xavier; Martins, Carole; Uzzan, Mathieu; Serrero, Melanie; Guillo, Lucas; Roblin, Xavier; Tedesco, Emilie Del; Beaugerie, Laurent; Seksik, Philippe; Bourrier, Anne; Landmann, Cecilia; Kirchgesner, Julien; Sokol, Harry; Buisson, Anthony; Nancey, Stephane; Boschetti, Gilles; Gay, Claire; Danion, Pauline; Flourié, Bernard; Abitbol, Vered; Malamut, Georgia; Reimund, Jean-Marie; Caron, Benedicte; Vuitton, Lucine; Peyrin-Biroulet, Laurent; Zallot, Camille; Gilletta, Cyrielle; Allez, Matthieu; Gornet, Jean-Marc; Baudry, Clotilde; Viennot, Stephanie; Bourreille, Arnaud; Trang-Poisson, Caroline; Boualit, Medina; Painchart, Claire; Plastaras, Laurianne; Altwegg, Romain; Boivineau, Lucile; Fumery, Mathurin; Laharie, David; Riviere, Pauline; Poullenot, Florian; Coffin, Benoit; Duboc, Henri; Nahon, Stephane; Simon, Marion; Coulibaly, Baya; Chanteloup, Elise; Fotsing, Ginette;
• Is Part Of: Digestive and liver disease. Volume 54:Issue 10(2022)
• Page Start: 1350
• Page End: 1357
• Publication Date: 2022-10
• Subjects: Anti-TNF -- Contraindication -- Crohn's disease -- Inflammatory bowel disease; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2022.04.011
• Languages: English
• ISSNs: 1590-8658

Abstract

Summary: Background: The exact rate of contraindications to anti-TNF therapy and physician perspectives on treatment choices facing to anti-TNF contraindication, are poorly reported. Methods: A two-week cross-sectional study was conducted in 31 centres. Physicians completed a questionnaire for a total of 1, 314 consecutive outpatients with Crohn's disease, assessing each patient's potential contraindications to anti-TNF therapy, the choice of alternative therapy to anti-TNFs, and their preference in an unrestricted reimbursement setting. Results: Among the 1, 293 responses to the first item, 148 (11.5%) reported 32 absolute contraindications (2.5%) and 116 relative contraindications (9.0%) to anti-TNF therapy. When asked about their preference of alternative therapies in those cases with contraindications to anti-TNF, physicians chose ustekinumab and vedolizumab, 75.6% and 23.9%, respectively. In multivariable analysis, the choice of vedolizumab was the preferred choice for patients aged > 60 years with the L2 phenotype and the absence of perianal lesions. In a hypothetical setting of unrestricted reimbursement, anti-TNFs remained physicians' preferred first-line biological therapy choice for 78.2%. Conclusion: Anti-TNF contraindications occurred in up to 11.5% of patients with Crohn's disease. Physicians' choices for alternative therapy to anti-TNF relied on ustekinumab in 75.6% and vedolizumab in 23.9% of these cases. This choice was driven mainly by phenotypical criteria and age.