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Conexiant chevron_right Gastroenterology chevron_right Prior TNF Antagonist Exposure Influences Efficacy of Advanced Therapies in Ulcerative Colitis
From the Journals

Prior TNF Antagonist Exposure Influences Efficacy of Advanced Therapies in Ulcerative Colitis

"Prior exposure to TNF antagonists appears to potentiate the efficacy of JAK inhibitors and IL-12/23 antagonists but may attenuate responsiveness to lymphocyte trafficking inhibitors."

Conexiant
Full Article Summary Notecard
  1. Prior TNF exposure significantly influences the effectiveness of advanced ulcerative colitis therapies.

  2. Lymphocyte trafficking inhibitors (vedolizumab, S1P modulators) are most effective in TNF-naive patients; efficacy drops around 50% after TNF exposure.

  3. IL antagonists (IL-12/23 and IL-23 blockers) perform well in both TNF-naive and TNF-exposed patients, though ustekinumab may have enhanced benefit post-TNF.

  4. JAK inhibitors demonstrate superior remission rates in TNF-exposed patients, supporting their use as rescue options after TNF failure.

  5. TNF blockade may leave a lasting “immunologic scar,” altering immune pathways in ways that differentially affect subsequent therapies.

  6. Patient treatment history should inform drug sequencing—favoring trafficking inhibitors in naive patients, JAK inhibitors in TNF-exposed patients, and IL antagonists across both.

  7. Prospective head-to-head trials are needed to validate sequencing strategies and clarify mechanisms of differential efficacy.

    Source: Clinical Gastroenterology and Hepatology

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