ArticleBMC gastroenterology2026
Real-world outcomes of tumour necrosis factor inhibitor (TNFi) cyclers versus mechanism-of-action switchers among ulcerative colitis patients who failed first-line TNFi.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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11 authors.
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Abstract
backgroundWe compared real-world outcomes among patients with ulcerative colitis (UC) prescribed second-line tumour necrosis factor inhibitor (TNFi) versus non-TNFi therapy after a first-line TNFi.
methodsWe included adults with ≥ 2 claims for UC and ≥ 1 medical or pharmacy claim for a UC-approved TNFi as first-line therapy between 1 January 2015 and 30 June 2022 from the Healthcare Integrated Research Database. Second-line therapy was identified by one or more claims for a different TNFi or non-TNFi. The primary outcome was inadequate response, a composite of at least one of switch/add alternative advanced therapy, augment with conventional therapy, dose escalation, glucocorticoid intensification, UC-related hospitalisation, or UC-related surgery. We used multivariable logistic regression with trimmed inverse probability treatment weighting (IPTW) to calculate adjusted odds of inadequate response with second-line TNFi versus non-TNFi.
resultsAmong 921 IPTW-weighted patients (second-line TNFi, n = 281; non-TNFi, n = 640), 62% of the TNFi cohort versus 49% non-TNFi had inadequate response (chi-square p = 0.001; odds ratio [95% CI], 1.76 [1.31-2.37], p < 0.001). Mean/median time to inadequate response among patients with inadequate response within 1 year was 139/125 days (TNFi) and 150/130 days (non-TNFi). The most common criterion for inadequate response was addition of new conventional therapy (35% second-line TNFi vs. 25% non-TNFi, p < 0.01); switch to or addition of alternative advanced therapy (30% vs. 15%, p < 0.01), and dose increase of oral glucocorticoids (14% vs. 9%, p < 0.05) were also significantly more common among patients in the TNFi cohort than the non-TNFi cohort. Total healthcare costs were modestly higher in the TNFi cohort.
conclusionsThese results suggest that patients with UC have higher odds of inadequate response with a second TNFi versus non-TNFi after a first TNFi failure. Switching to an alternate mechanism of action for second-line therapy yielded better clinical outcomes.
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