Anti-TNF therapy is a mainstay of treatment for Crohn’s disease although treatment failure in patients with IBD is common. touchIMMUNOLOGY were delighted to speak with Simeng Lin (University of Exeter Medical School, Exeter, UK) to discuss the current standard of care for Crohn’s disease, anti-TNF therapy and factors thought to predict non-response to anti-TNF treatment.
The abstract ‘Understanding the molecular mechanisms of anti-TNF treatment failure: Whole blood DNA methylation changes associated with primary non-response to anti-TNF treatment in patients with Crohn’s disease.’ (Abstract number: DOP88) was presented at ECCO 2023, March 1-4, 2023.
Questions
- What is the current standard of care for Crohn’s disease (CD) and where does anti-TNF therapy fit into the treatment paradigm? (0:15)
- What do we already know about anti-TNF treatment failure and which factors are thought to predict non-response? (1:19)
Disclosures: Simeng Lin discloses receiving honoraria from Pfizer unrelated to this video.
Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Victoria Jones.
Filmed in coverage of the European Crohn´s and Colitis Organisation Annual Meeting 2023.
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Transcript
What is the current standard of care for Crohn’s disease (CD) and where does anti-TNF therapy fit into the treatment paradigm? (0:15)
Over the last few years, we’ve actually had quite a few new therapeutic options that have been approved for the treatment of Crohn’s disease. And alongside these, quite a few recent network meta-analysis have been performed compared efficacy of these new treatments for both induction and maintenance of remission in Crohn’s disease. And these studies have actually showed that anti-TNF therapy to be still highly effective in inducing and maintaining clinical remission. And so, in many treatment centres, anti-TNF therapy still remains the first line treatment for Crohn’s disease. And certainly there are a few special situations where you might choose to use anti-TNF therapy over other options, such as in those with perianal disease or those with extra intestinal manifestations.
What do we already know about anti-TNF treatment failure and which factors are thought to predict non-response? (1:19)
In the personalised anti-TNF therapy in Crohn’s disease study, or otherwise known as the PANTS study, which was a UK wide prospective cohort study of more than 1,600 anti-TNF naive patients starting anti-TNF treatment. We found low anti-TNF drug concentrations at week 14 was associated with both primary non-response at weeks 14 and non-remission at week 54. In the same cohort, we used genetics from the same patients and found the carriage of the HLA-DQA1*05 variant was associated with the development of immunogenicity or otherwise known as anti-drug antibodies, which in turn mediates non-remission. And over the last few years, there has been a drive to identify other molecular markers to understand anti-TNF treatment failure, specifically using epigenetics, transcriptomics and proteomics. Although the clinical translation of these markers at present is limited.
Subtitles and transcript are autogenerated.
