Crohn's disease, 2nd line biologic (NICE TA187) and LSCMMG Recommendation
In CD patients who experience intolerance, secondary failure or primary failure with a first TNF-alpha inhibitor used in line with NICE, treatment with a second NICE TA187-approved TNF-alpha inhibitor may be tried. There is consistent evidence that a second TNF-alpha inhibitor can induce and maintain clinical response and remission in many patients who experience inadequate control or intolerance on their first TNF-alpha inhibitor. Response and remission rates with a second TNF-alpha inhibitor are highest in those who discontinue their first TNF-alpha inhibitor due to intolerance or loss of response, compared with those who discontinue due to lack of an adequate initial response.
Reason for decision: