Testing for loss of response could shape future IBD care
ORLANDO — Adding genetic testing to the management of patients with inflammatory bowel disease may present an opportunity to determine which patients are at greater risk for loss of response and help select the best therapies for each individual patient, according to an expert.
Jami Ann Rothe Kinnucan, MD, of Michigan Medicine, told Healio Gastroenterology and Liver Disease that identifying potential for loss of response is critical.
“Patients with inflammatory bowel disease, both Crohn's and ulcerative colitis, have an increased risk for loss of response to their anti-TNF therapy,” she said in an interview. “That could be due to low drug levels, that could lead to infusion reactions, that could lead to overall clinical loss of response, and the thought is due to antibody or antidrug antibody formation.”
In a presentation at Advances in Inflammatory Bowel Disease annual meeting, Kinnucan discusses research on the HLA-DQA15 allele and its ability to help predict loss of response. In a prospective study comprising more than 1,600 patients in Europe, researchers forming the PANTS consortium found that the presence of the allele was associated with a significant likelihood of loss of response due to antibody formation to both Remicade (infliximab, Janssen) and Humira (adalimumab, AbbVie), according to Kinnucan. The highest rate for loss of response — up to 92% — was found among patients on infliximab monotherapy without an immunomodulator.
“These patients should be on combination therapy at minimum,” Kinnucan said. “But is this someone I would consider a non-anti-TNF therapy as first-line biologic vs. using an anti-TNF, especially knowing the results of this lab test?”
Although she is unsure if the test is ready for clinical practice, Kinnucan said it is definitely something to keep track of as more research comes to light.
“It raises some interesting questions,” Kinnucan said. “There is some follow-up that will need to happen and discussions about what is appropriate and how do we put this in clinical practice and how do we disseminate it outside of IBD centers into the community who are very much prescribing these therapies.” – by Alex Young
Kinnucan J. Study 6: PANTS. Presented at: Advances in Inflammatory Bowel Disease; Dec. 12-14, 2019; Orlando.
Disclosure: Kinnucan reports she is a consultant for Janssen.