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María José Casanova, María Chaparro, Javier P Gisbert, Response to the Letter to the Editor: “Response to Infliximab After Loss of Response to Adalimumab in Crohn’s Disease”, Inflammatory Bowel Diseases, Volume 26, Issue 2, February 2020, Page e6, https://doi.org/10.1093/ibd/izz287
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To the Editor:
Please find below a response to Dr. Bauer et al.
Bauer et al. present an interesting study of 78 Crohn’s disease patients treated with adalimumab who switched to infliximab (IFX) due to loss of response. At week 54, as many as 78% of the patients maintained response to IFX. These results are similar to those reported in our study, which includes the largest cohort of inflammatory bowel disease (IBD) patients in whom the strategy of switching to a second anti–tumor necrosis factor (anti-TNF) has been evaluated. According to our results, a relevant proportion of patients achieve remission with the second anti-TNF. In fact, 1 year after switching, 77% of the IBD patients who initially achieved remission with the second anti-TNF maintained remission.1
In view of our results, we agree that switching to a second anti-TNF may be a good option, especially in those patients who were intolerant to or who lost response to a first anti-TNF agent. In this respect, a recent meta-analysis published by our group showed that the rate of remission was higher in those patients who switched to a second anti-TNF due to intolerance of the first drug (61%), in comparison with secondary (45%) or primary failure (30%).2 Nevertheless, it is important to remark that, according to our results, a high proportion of patients who achieved remission with a second anti-TNF lost efficacy during follow-up. Given these results, before making the decision of switching to a second anti-TNF, we should carefully take into account the reason for switching and the probability of loss of response.
