Predictors of anti-TNF treatment failure in anti-TNF-naive patients with active luminal Crohn's disease: a prospective, multicentre, cohort study

The personalised anti-TNF therapy in Crohn's disease study (n=955; PANTS) reports anti-TNF treatment failure is common and is predicted by low drug concentrations, mediated in part by immunogenicity, with suboptimal week 14 drug concentrations predicting immunogenicity.

A total of 1610 patients were enrolled, and primary non-response was reported in 295 (23.8%) of 1241 patients who were assessable at week 14. Non-remission at week 54 occurred in 764 (63.1%) of 1211 patients who were assessable.

 

The only factor independently associated with primary non-response was reported to be low drug concentration at week 14, with the optimal week 14 drug concentrations associated with remission at both week 14 and week 54 of 7mg/L for infliximab and 12mg/L for adalimumab. The researchers also reported that continuing standard dosing regimens after primary non-response was rarely helpful as the proportion of patients who developed anti-drug antibodies was 62.8% (95% CI 59.0–66.3) for infliximab and 28.5% (24.0–32.7) for adalimumab at week 14.