Why Do Some IBD Patients Have Poor Response to Treatment?

Colonic involvement is associated with non-response or lost response to anti-tumor necrosis factor (TNF) treatment in some patients with inflammatory bowel disease (IBD), a recent study showed.

For their study, the researchers evaluated 314 patients (51 primary non-responders and 179 secondary non-responders) with Crohn disease (CD) and 145 patients (43 primary non-responders and 74 secondary non-responders) with ulcerative colitis. Primary non-responders did not respond to anti-TNF treatment at all, and secondary non-responders had lost response over time.
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Overall, the researchers found that colonic involvement and anti-TNF monotherapy were associated with primary non-response in patients with CD. Additionally, for all patients with IBD, loss of response to anti-TNF agents was linked to higher anti-nuclear cytoplasmic antibody levels in CD, anti-nuclear cytoplasmic antibody positivity in ulcerative colitis, and a positive family history of IBD.

Several known IBD susceptibility single-nucleotide polymorphisms and additional variants in immune-mediated genes were also found be related to primary and secondary nonresponse.

“Our results may help to optimize the use of anti-TNF agents in clinical practice and position these therapies appropriately as clinicians strive for a more personalized approach to managing IBD,” the researchers concluded.

—Christina Vogt

Reference:

Yoon SM, Haritunians T, Chhina S, et al. Colonic phenotypes are associated with poorer response to anti-TNF therapies in patients with IBD [Published online June 7, 2017]. Inflamm Bowel Dis. doi:10.1097/MIB.0000000000001150.