{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T08:55:58Z","timestamp":1776329758159,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Sequencing therapy for Crohn\u2019s disease (CD) is currently being intensively discussed due to the development of novel drugs and lack of standardized criteria for drug positioning in first- and further-line treatment. The aim of this study was to compare the efficacy of a second-line advanced therapy in Romanian patients with CD who have failed an anti-TNF agent. Methods: We performed a multicenter retrospective study that included adult patients with CD who had secondary loss of response after an initial response with an anti-TNF drug. The main outcome was clinical remission at 12 weeks of second-line treatment (CDAI &lt; 150). The secondary outcomes included clinical response (decrease in CDAI \u2265 70 points), persistence of therapy at 1 year and rates of adverse events. Results: From 2008 to 2024, 216 patients were either switched to another anti-TNF or swapped to another therapeutic class, due to the failure of a first anti-TNF drug. Secondary lines of treatment included infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST). The highest rate of clinical remission (81%) was obtained with the sequence ADA-IFX in 26\/32 (81%) patients and ADA-UST in 62\/82 (76%) patients, followed by IFX-UST in 22\/33 (67%) and IFX-ADA 34\/51 (67%). Persistence in therapy at 1 year was better for the sequence ADA-UST (73%) and IFX-UST (67%) and ADA-IFX (63%) compared to IFX-ADA (59%) and IFX-VDZ (44%) (p &lt; 0.001). Conclusions: There were significant baseline differences between the treatment groups, so this study represents an unadjusted comparison between the results obtained with different biologics in second-line treatment for Crohn\u2019s disease. In patients with CD who have failed a first anti-TNF, the highest rate of clinical remission at 12 weeks was obtained with second-line IFX and UST whilst vedolizumab showed lower efficacy. UST demonstrated the most favorable long-term treatment persistence at 1 year.<\/jats:p>","DOI":"10.3390\/jcm15083029","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T07:37:19Z","timestamp":1776325039000},"page":"3029","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Second-Line Advanced Therapy in Patients with Crohn\u2019s Disease After Failure of a First Anti-TNF: A Descriptive Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Corina","family":"Meianu","sequence":"first","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen Monica","family":"Preda","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircea","family":"Diculescu","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doina","family":"Istratescu","sequence":"additional","affiliation":[{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9144-5520","authenticated-orcid":false,"given":"Anca","family":"Trifan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-0779","authenticated-orcid":false,"given":"Alina","family":"Tantau","sequence":"additional","affiliation":[{"name":"Cluj CF University Hospital, UMF \u201cIuliu Hatieganu\u201d Cluj, 400347 Cluj, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-548X","authenticated-orcid":false,"given":"Ana Maria","family":"Singeap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5348-0341","authenticated-orcid":false,"given":"Cristian George","family":"Tieranu","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Elias Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7736-8140","authenticated-orcid":false,"given":"Horia","family":"Minea","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana-Maria","family":"Buzuleac","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3042-0754","authenticated-orcid":false,"given":"Lucian","family":"Negreanu","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Internal Medicine Department, Emergency Universitary Hospital, 050471 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remus","family":"Popescu","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Emergency Universitary Hospital, 050471 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7460-3830","authenticated-orcid":false,"given":"Andreea","family":"Bota","sequence":"additional","affiliation":[{"name":"Gastroenterology & Hepatology Department, Elias Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tudor","family":"Stroie","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Letitia","family":"Tugui","sequence":"additional","affiliation":[{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea-Maria","family":"Cazimirovitz","sequence":"additional","affiliation":[{"name":"Gastroenterology & Hepatology Department, Elias Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosmin Alexandru","family":"Ciora","sequence":"additional","affiliation":[{"name":"UMF \u201cCarol Davila\u201d, Gastroenterology & Hepatology Department, 020021 Bucharest, Romania"},{"name":"Gastroenterology & Hepatology Department, Clinic Fundeni Institute, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/S0140-6736(16)31711-1","article-title":"Crohn\u2019s disease","volume":"389","author":"Torres","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S2468-1253(19)30333-4","article-title":"The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"5","author":"Alatab","year":"2020","journal-title":"Lancet Gastroenterol. 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