Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus
Background Despite research, there are still controversial areas in the management of Crohn’s disease (CD).Objective To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD.Methods Clinical controversies in the management of CD u...
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/11/1/e001246.full |
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| author | Ignacio Marin-Jimenez Guillermo Bastida Daniel Carpio Fernando Muñoz Yago González-Lama Elena Ricart Daniel Ceballos Daniel Ginard Luis Menchen |
| author_facet | Ignacio Marin-Jimenez Guillermo Bastida Daniel Carpio Fernando Muñoz Yago González-Lama Elena Ricart Daniel Ceballos Daniel Ginard Luis Menchen |
| author_sort | Ignacio Marin-Jimenez |
| collection | DOAJ |
| description | Background Despite research, there are still controversial areas in the management of Crohn’s disease (CD).Objective To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD.Methods Clinical controversies in the management of CD using anti-TNF therapies were identified. A comprehensive literature review was performed, and a national survey was launched to examine current clinical practices when using anti-TNF therapies. Their results were discussed by expert gastroenterologists within a nominal group meeting, and a set of statements was proposed and tested in a Delphi process.Results Qualitative study. The survey and Delphi process were sent to 244 CD-treating physicians (response rate: 58%). A total of 14 statements were generated. All but two achieved agreement. These statements cover: (1) use of first-line non-anti-TNF biological therapy; (2) role of HLA-DQA1*05 in daily practice; (3) attitudes in primary non-response and loss of response to anti-TNF therapy due to immunogenicity; (4) use of ustekinumab or vedolizumab if a change in action mechanism is warranted; (5) anti-TNF drug level monitoring; (6) combined therapy with an immunomodulator.Conclusion This document sought to pull together the best evidence, experts’ opinions, and treating physicians’ attitudes when using anti-TNF therapies in patients with CD. |
| format | Article |
| id | doaj-art-188a1c6750424b6db0c6d7db3b8a1ef6 |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-188a1c6750424b6db0c6d7db3b8a1ef62025-02-07T14:30:11ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742024-01-0111110.1136/bmjgast-2023-001246Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensusIgnacio Marin-Jimenez0Guillermo Bastida1Daniel Carpio2Fernando Muñoz3Yago González-Lama4Elena Ricart5Daniel Ceballos6Daniel Ginard7Luis Menchen8Hospital General Universitario Gregorio Marañón, Madrid, SpainGastroenterology Department, Polytechnic Hospital, Valencia, SpainGastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, SpainGastroenterology Department, Hospital Universitario de Salamanca, Salamanca, SpainGastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, SpainGastroenterology Department, CIBEREHD, Madrid, Spain29 Gastroenterology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, SpainGastroenterology Department, Hospital Universitario Son Espases, Palma, SpainGastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, SpainBackground Despite research, there are still controversial areas in the management of Crohn’s disease (CD).Objective To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD.Methods Clinical controversies in the management of CD using anti-TNF therapies were identified. A comprehensive literature review was performed, and a national survey was launched to examine current clinical practices when using anti-TNF therapies. Their results were discussed by expert gastroenterologists within a nominal group meeting, and a set of statements was proposed and tested in a Delphi process.Results Qualitative study. The survey and Delphi process were sent to 244 CD-treating physicians (response rate: 58%). A total of 14 statements were generated. All but two achieved agreement. These statements cover: (1) use of first-line non-anti-TNF biological therapy; (2) role of HLA-DQA1*05 in daily practice; (3) attitudes in primary non-response and loss of response to anti-TNF therapy due to immunogenicity; (4) use of ustekinumab or vedolizumab if a change in action mechanism is warranted; (5) anti-TNF drug level monitoring; (6) combined therapy with an immunomodulator.Conclusion This document sought to pull together the best evidence, experts’ opinions, and treating physicians’ attitudes when using anti-TNF therapies in patients with CD.https://bmjopengastro.bmj.com/content/11/1/e001246.full |
| spellingShingle | Ignacio Marin-Jimenez Guillermo Bastida Daniel Carpio Fernando Muñoz Yago González-Lama Elena Ricart Daniel Ceballos Daniel Ginard Luis Menchen Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus BMJ Open Gastroenterology |
| title | Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus |
| title_full | Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus |
| title_fullStr | Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus |
| title_full_unstemmed | Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus |
| title_short | Controversies in the management of anti-TNF therapy in patients with Crohn’s disease: a Delphi consensus |
| title_sort | controversies in the management of anti tnf therapy in patients with crohn s disease a delphi consensus |
| url | https://bmjopengastro.bmj.com/content/11/1/e001246.full |
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