Five recent developments in anti-TNF therapies for patients with IBD

A recent influx of research on anti-tumor necrosis factor therapies for patients with ulcerative colitis and Crohn’s disease has provided valuable new data to clinicians who treat patients with inflammatory bowel disease. Here are five highlights of anti-TNF studies presented this month on Healio.com/Gastroenterology.

1. The three leading anti-TNF agents all had comparable efficacy for treatment of Crohn’s disease

A meta-analysis performed by Akbar K. Waljee, MD, University of Michigan Health System and colleagues indicated no clinical superiority among infliximab, adalimumab or certolizumab pegol for treatment of patients with Crohn’s disease.

Akbar K. Waljee

“In the absence of compelling data demonstrating variable efficacy, factors including safety, cost and patient preference should guide anti-TNF choice and sequencing,” the researchers concluded. Read more

2. Monitoring adalimumab levels predicted remission after dose optimization in patients with IBD

Researchers from France developed a drug-monitoring algorithm that predicted clinical response after adalimumab dose optimization in patients with Crohn’s disease or ulcerative colitis who previously experienced loss of clinical response to adalimumab therapy.

“The presence of low adalimumab trough levels without [antibodies against adalimumab] levels is strongly predictive of a favorable response to … optimization in 67% of cases,” the researchers wrote. Read more

3. Anti-TNF-a was superior to routine therapy at inducing remission in children with Crohn’s disease

In a series of nonrandomized clinical trials, Michael D. Kappelman, MD, associate professor of pediatrics, University of North Carolina, and colleagues observed that for children with Crohn’s disease, anti-TNF-alpha therapy was more effective at inducing disease remission than traditional therapeutic strategies administered in routine gastroenterology practice settings.

Michael D. Kappelman

“Our findings suggest that anti-TNF-a agents are comparatively more effective than usual care for treating children who have moderate to severe Crohn’s disease,” the investigators wrote. Read more

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4. Anti-TNF-a not associated with increased cancer risk in patients with IBD

Patients with inflammatory bowel disease who were exposed to tumor necrosis factor-alpha antagonists showed no significantly increased risk for cancer, according to a recent nationwide cohort study conducted by Nynne N. Andersen, MD, PhD student, department of epidemiology research, Statens Serum Institut, Copenhagen, Denmark, and colleagues.

Nynne N. Andersen

“The study ... confirms and expands on previous literature and provides reassuring results on the long-term safety of TNF-a antagonists,” Andersen told Healio.com/Gastroenterology. Read more

5. Adalimumab, immunomodulator combination therapy associated with increased cancer risk in patients with Crohn’s disease

Combination adalimumab and immunomodulator therapy in patients with Crohn’s disease was associated with an increased risk for nonmelanoma skin cancer, as well as other cancers, according to data from a pooled analysis performed by Mark T. Osterman, MD, University of Pennsylvania, Perelman School of Medicine, and colleagues.

Mark T. Osterman

“For patients who are on step-up combination therapy in the setting of ineffective or incompletely effective thiopurine therapy, the potential risks of malignancy should be weighed against the potential benefits of increasing anti-TNF drug levels and suppressing antibody formation when deciding upon continuation or discontinuation of the thiopurine,” Osterman told Healio.com/Gastroenterology. Read more