The effectiveness of second- and-third-line biologics in perianal Crohn’s disease—a multicenter propensity score-matched study
BACKGROUND & AIMS: Anti-tumor necrosis factor-alpha inhibitors (anti-TNFs) are the established treatment for perianal Crohn's disease (pCD), but relapse and non-response are common. Data on 2nd- and 3rd-line biologics are limited. We present the first direct comparison of 2nd - and 3rd -lin...
Elmentve itt :
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| Dokumentumtípus: | Cikk |
| Megjelent: |
2025
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| Sorozat: | JOURNAL OF CROHNS & COLITIS
19 No. 6 |
| Tárgyszavak: | |
| doi: | 10.1093/ecco-jcc/jjaf099 |
| mtmt: | 36192916 |
| Online Access: | http://publicatio.bibl.u-szeged.hu/37233 |
| Tartalmi kivonat: | BACKGROUND & AIMS: Anti-tumor necrosis factor-alpha inhibitors (anti-TNFs) are the established treatment for perianal Crohn's disease (pCD), but relapse and non-response are common. Data on 2nd- and 3rd-line biologics are limited. We present the first direct comparison of 2nd - and 3rd -line biologics in pCD patients with active perianal disease previously treated with 1st-line anti-TNFs.; METHODS: A multicenter retrospective cohort study included adult patients with pCD who failed 1st-line anti-TNF. The primary outcome was clinical perianal response, with secondary outcomes of radiological response (magnetic resonance imaging [MRI] or transrectal ultrasound [TRUS]) and healing, and clinical remission. Propensity-score matching (PSM) was used to adjust for baseline differences.; RESULTS: A total of 486 pCD patients from 23 IBD centers were included, with 333/486 (68.5%) and 216/263 (82.1%) matched by PSM in the 2nd and 3rd -line treatment groups, respectively. In the 2nd -line group, 62/78 (79.5%) of ustekinumab (UST)-treated patients achieved clinical perianal response, compared to 46/78 (58.9%) with vedolizumab (VDZ) (OR 4.47, 95% CI 1.94-10.28, p<0.001) and 38/78 (48.7%) with anti-TNFs (OR 5.29, 95% CI 2.39-11.71, p<0.001). In the 3rd-line group, 38/49 (77.6%) of UST-treated patients achieved clinical perianal response, compared to 29/49 (59.2%) with VDZ (OR 9.96, 95% CI 2.6-38.4, p<0.001) and 27/49 (55.1%) with anti-TNFs (OR 12.03, 95% CI 2.99-48.47, p<0.001). UST-treated patients also had higher radiological response rates than VDZ (OR 3.28, 95% CI 1.07-10.07, p=0.038).; CONCLUSION: In pCD patients failing anti-TNFs as 1st-line treatment, ustekinumab may be more effective than vedolizumab or another anti-TNFs as 2nd or 3rd-line therapy. © The Author(s) 2025. Published by Oxford University Press on behalf of European Crohns and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our sitefor further information please contact journals.permissions@oup.com. |
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| Terjedelem/Fizikai jellemzők: | 14 |
| ISSN: | 1873-9946 |