Management of Primary Nonresponders and Partial Responders to Tumor Necrosis Factor-α Inhibitor Induction Therapy among Patients with Crohn's Disease

Hideki Iijima; Taku Kobayashi; Mitsuo Nagasaka; Shinichiro Shinzaki; Kazuya Kitamura; Yasuo Suzuki; Mamoru Watanabe; Toshifumi Hibi

doi:10.1159/000506337

Management of Primary Nonresponders and Partial Responders to Tumor Necrosis Factor-α Inhibitor Induction Therapy among Patients with Crohn's Disease

Inflamm Intest Dis. 2020 Jun;5(2):78-83. doi: 10.1159/000506337. Epub 2020 Mar 6.

Authors

Hideki Iijima¹, Taku Kobayashi², Mitsuo Nagasaka³, Shinichiro Shinzaki¹, Kazuya Kitamura⁴, Yasuo Suzuki⁵, Mamoru Watanabe⁶, Toshifumi Hibi²

Affiliations

¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
² Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
³ Department of Gastroenterology, Fujita Health University, Toyoake, Japan.
⁴ Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
⁵ Department of IBD Center, Toho University Sakura Medical Center, Sakura, Japan.
⁶ Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

Induction therapy with tumor necrosis factor-α (TNF-α) inhibitors is highly effective for the treatment of Crohn's disease. However, there are primary nonresponders (PNR) of TNF-α inhibitors without clinical response during the induction period. In addition, there are partial responders (PR), who show some efficacy, but clinical remission is not achieved by induction therapy. To date, the definition and clinical management of PNR and PR have not been established. This report summarizes the opinions of 36 Japanese experts attending the Japan Round Table Discussion on IBD Meeting regarding how to determine PNR and PR of TNF-α inhibitors and how to manage these patients in clinical practice. PNR, who do not show any initial improvement of clinical symptoms and serum C-reactive protein (CRP) levels, require re-assessment of intestinal complications. PR can be determined either by clinical symptoms, serum CRP levels, or imaging results. PR need intensification of the treatment with TNF-α inhibitors either with or without optimization of immunomodulators. Optimization of initial TNF-α inhibitor therapy may improve long-term outcomes, but more evidence is required to improve the use of TNF-α inhibitors for the prevention and management of PNR and PR.

Keywords: Crohn's disease; Expert opinion; Infliximab; Partial responder; Primary nonresponder.