By Ed Susman
SAN ANTONIO, Tex -- October 20, 2010 -- Patients diagnosed with Crohn's disease who smoke cigarettes or use narcotics appear less likely to respond to treatment with biologic agents, researchers said here at the American College of Gastroenterology (ACG) 75th Annual Scientific Meeting.
"I think we should advise patients with Crohn's disease to stop smoking and to stop using narcotics if they are going to use biologic agents for this disease," said Ira Shafran, MD, Shafran Gastroenterology Center, Winter Park, Florida, on October 17.
Dr. Shafran and colleagues conducted a retrospective review among 44 patients who were not responding to therapy with the anti-tumour necrosis factor (TNF) agent infliximab.
When these nonresponders were subsequently treated with a second anti-TNF agent adalimumab, about 34% of them did respond.
When the researchers analysed possible reasons for nonresponse, he observed that 45% of these patients were smokers while only 7% of responders were current smokers.
He said 55% of nonresponders were also taking narcotics compared with 13% of the responders.
Dr. Shafran added that nonresponders to infliximab therapy were more likely not to respond to subsequent treatment with adalimumab. Of the 44 patients in the study who did not respond to infliximab, 29 did not respond to adalimumab.
"Infliximab is an effective therapy for Crohn's disease," Dr. Shafran explained, "but its chimeric nature may induce human antichimeric antibody responses, resulting in infusion reactions, elevated immune responses, and loss of efficacy in some patients." He said that as many as 40% of patients on infliximab may either become intolerant of the treatment of might stop responding to therapy.
His study group of 18 men and 26 women with a mean age of about 39 years had been treated for Crohn's disease for about 18 years.
In addition to smoking and narcotic use, Dr. Shafran said that presence of fibrostenotic disease and steroid use also indicated that patients were unlikely to respond to adalimumab.
He said that in his practice he recommends the following:
? Patients with advanced fibrostenotic disease should be considered for surgery.
? Cessation of smoking and narcotic use should occur before adalimumab therapy.
? Patients who are steroid-dependent at baseline may be counterindicated for adalimumab therapy.
Among other patients who were not responding to infliximab, however, Dr. Shafran said that treatment with adalimumab was able to induce and maintain remission of Crohn's disease symptoms.
[Presentation title: Efficacy of Adalimumab Therapy in Patients With Crohn's Disease Who Were Unresponsive to or Intolerant of Infliximab: Six Years of Experience in a Single Gastroenterology Center. Abstract P279]
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