Background: A nti-TNF d rugs (Infliximab (IFX), Adalimumab
(ADA), Certolizumab pegol (CZP)) are effective in inducing and
maintaining response a nd remission in i nflammatory bowel
disease (IBD). Insufficient response or side effects may lead to
a switch o f the anti-TNF d rug. W e aimed to e valuate the
frequency and reasons for anti-TNF switches.
Methods: Analysis of data from the Swiss Inflammatory Bowel
Disease Cohort (SIBDCS). Eighty percent of included patients
were recruited in hospitals and 20% from private practice.
Results: From 2,058 patients ( 1,172 with Crohn's disease
(CD), 842 with ulcerative colitis (UC) and 44 with indeterminate
colitis (IC)), 772 received at least one anti-TNF. Forty-eight % of
patients w ith CD, 23% with U C, a nd 30% with IC w ere ever
treated with an anti-TNF drug. There was no gender difference
with respect to the frequency of a nti-TNF treatment. A total of
584 patients (76%) were treated with one, 142 (18%) with two,
and 46 (6%) with three anti-TNF (of which 32 were female). A
total of 89% patients were treated with IFX, 28% ADA and 13%
with CZP. Overall response rate (defined as drop in CDAI >100
points) to anti-TNF was 50%, with best response rates for the
first used anti-TNF. Reasons t o switch t he anti-TNF w ere in
11% a primary non-response, in 38% a loss of response and in
36% anti-TNF s ide effects o r intolerance ( reasons for 15% of
treatment failures not documented).
Conclusion: A nti-TNF d rugs were used in h alf of the CD
patients a nd in o ne quarter of U C patients. Anti-TNF d rug
switch d ue to insufficient response a nd/or side effects w as
necessary in one quarter of IBD patients. IFX was mainly used
as first-line therapy. Best response rates were observed for the
first used anti-TNF. Following analyses will identify risk median
treatment duration as well as risk factors for anti-TNF switch.