Loss of response to anti-TNF therapy in inflammatory bowel disease: experience in a reference hospital in Lima - Peru

Paredes Méndez J.E.; Alosilla Sandoval P.A.; Vargas Marcacuzco H.T.; Mestanza Rivas Plata A.L.; Gonzá Les Yovera J.G. · Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru (2020)

Resumen

OBJECTIVE: To evaluate the response to treatment with anti-TNFs in patients with inflammatory bowel disease. MATERIALS AND METHODS: Prospective observational study conducted in the Gastroenterology service of the Guillermo Almenara National Hospital, from January 2015 to August 2018. RESULTS: 31 patients with inflammatory bowel disease who received maintenance therapy with Infliximab were evaluated. Twelve (38.7%) patients (3 with ulcerative colitis and 9 with Crohn's disease) presented loss of response after 6 months of the beginning of the maintenance phase: 2 between 6-12 months, 4 between 12-18 months and 6 between 18- 24 months. As a first step, the dose was doubled (10 mg/kg) to the 12 patients, obtaining a response in 6 (50%) after 12 weeks. Of the remaining 6 patients, 4 switched to Adalimumab, 1 patient presented colon cancer and 1 patient presented anaphylaxis and sarcoidosis. Of the patients who received Adalimumab, 3 had endoscopic recurrence (75%) after 6 months and 1 did not respond to induction therapy and was subjected to colectomy (25%). CONCLUSIONS: Approximately one third of our patients presented loss of response to maintenance therapy with Infliximab. The dose escalation as a rescue therapy was successful in half of the patients. The change to Adalimumab in patients with loss of response to a first anti-TNF drug does not seem to be effective.