Most Read Articles
Pearl Toh, 6 days ago
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Pearl Toh, 21 Sep 2020
Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.
2 days ago
Nocturia is a risk factor for mortality, according to the results of the Nagahama Study, which boasts of a low incidence of missing data and high representation of the general population.
Audrey Abella, 14 Oct 2020
Despite a 90-percent cure rate after first treatment for children with acute lymphoblastic leukaemia (ALL), approximately 10–15 percent of patients with paediatric ALL will experience relapse. [Expert Rev Anticancer Ther 2017;17:725-736] A recent webinar on the current landscape of ALL highlighted the potential of immunotherapy for paediatric patients with relapsed or refractory ALL, thus providing hope for this high-risk patient group.

Failing first-line IBD therapy may impact future response

Pearl Toh
21 Feb 2018

Patients with inflammatory bowel disease (IBD) who had primary nonresponse ─ or inadequate response to the initial loading doses to an anti-tumour necrosis factor (TNF) agent were less likely to respond to second-line biologics compared with those who had secondary loss of response (LOR) or intolerance to the primary therapy, according to a systematic review and meta-analysis presented at the Crohn's & Colitis Congress (CCC) 2018 held recently in Las Vegas, Nevada, US.        

“Primary nonresponse to anti-TNF therapy is seen in 35 to 65 percent of IBD patients and another 40 to 60 percent lose responsiveness during the first year of treatment,” said lead author Dr Siddharth Singh from the Division of Gastroenterology at University of California San Diego in La Jolla, California, US. “Physicians struggle with what treatments to recommend for these patients.”

The meta-analysis included eight randomized controlled trials of biologics in IBD patients previously treated with anti-TNF agents. Patient’s response to second-line treatment, or clinical remission, was stratified according to reasons for primary therapy discontinuation (ie, primary nonresponse, LOR, or intolerance). [CCC 2018, abstract P154]

Compared with primary therapy discontinuation due to intolerance, discontinuation due to primary nonresponse was associated with a 24 percent decreased likelihood of clinical remission with second-line biologics (relative risk [RR], 0.76, 95 percent confidence interval [CI], 0.61–0.96).  

Also, patients with prior primary nonresponse were 27 percent less likely to achieve clinical remission during induction with second-line biologics than those with secondary LOR, showing signs of disease activity despite ongoing therapy and after an initial response (RR, 0.73, 95 percent CI, 0.56–0.97). In particular, response to the second-line biologic ustekinumab was 36 percent less in those with primary nonresponse vs secondary LOR.    

Response to second-line vedolizumab was not significantly different regardless of whether patients discontinued their first-line anti-TNF agents due to primary nonresponse or secondary LOR (RR, 1.16, 95 percent CI, 0.85–1.58).

“Patients with primary nonresponse to anti-TNF agents are less likely to respond to second-line biologics, as compared to patients who discontinued therapy due to secondary LOR or intolerance,” the researchers concluded.

“These findings raise important questions about the biology of IBD, including the pharmacology of anti-TNF in a subset of patients,” said Singh.

 

 

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 6 days ago
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Pearl Toh, 21 Sep 2020
Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.
2 days ago
Nocturia is a risk factor for mortality, according to the results of the Nagahama Study, which boasts of a low incidence of missing data and high representation of the general population.
Audrey Abella, 14 Oct 2020
Despite a 90-percent cure rate after first treatment for children with acute lymphoblastic leukaemia (ALL), approximately 10–15 percent of patients with paediatric ALL will experience relapse. [Expert Rev Anticancer Ther 2017;17:725-736] A recent webinar on the current landscape of ALL highlighted the potential of immunotherapy for paediatric patients with relapsed or refractory ALL, thus providing hope for this high-risk patient group.