30
trying a second anti-TNFα agent. We do not advocate switching unless the patient
has lost response or been intolerant to a specific anti-TNFα therapy because this will
increase the risk of the development of antibodies to the previous anti-TNFα ther-
apy. Additionally, it has been shown that those patients started on a second anti-
TNFα therapy generally have a lower response and remission rate compared to the
first anti-TNFα agent. The utilization of concomitant immune suppression with
anti-TNFα therapy will be discussed in detail in another chapter. However, in gen-
eral we recommend that the majority of patients, unless there is intolerance or
contraindication, should be on concomitant immune suppression when on an anti-
TNFα therapy.
Patient education regarding the risks and benefits of anti-TNFα therapy is criti-
cal. It is also extremely important for patients to understand that interruption of
therapy can result in antibody formation and loss of response. Therefore, adher-
ence is an essential issue with regard to the long-term maintenance with anti-
TNFα therapy.
In summary, for UC patients who have failed first-line therapy, anti-TNFα ther-
apy can be utilized for the induction and maintenance of remission. Anti-TNFα
therapy is relatively safe and effective for the treatment of UC provided patients are
selected to ensure there are no treatment contraindications and that all patients are
monitored carefully.
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