Alternative Therapies for Patients With Crohn Disease With Anti-TNF Contraindications

Researchers assessed physicians’ choice of alternative therapy to anti-TNFs when facing contraindications in patients with Crohn disease.

Contraindications for use of anti-tumor necrosis factor (TNF) therapies occur in 11.5% of patients with Crohn disease (CD), which results in physicians prescribing ustekinumab and vedolizumab as alternative therapies, according to study findings published in Digestive and Liver Disease.

Researchers conducted a cross-sectional survey filled out by 1293 physicians treating 1314 adult outpatient with CD seen during 2 consecutive weeks in September 2020 in 31 tertiary centers throughout France.

Physicians reported absolute anti-TNF contraindications in 32 (2.5%) patients due to multiple sclerosis, chronic cardiac failure, comorbid neoplasia, increased infection risk, and anti-TNF adverse event history. Physicians reported relative contraindications in 116 (9.0%) patients corresponding to history of neoplasia, increased infection risk, various comorbidities, systemic lupus erythematosus, and anti-TNF adverse event history.

Physicians prescribed ustekinumab (75.6%) followed by vedolizumab (23.9%) and tofacitinib (0.5%) to treat patients with anti-TNF contraindications. Ustekinumab use was significantly increased for men, L1 and B2 phenotypes, presence of perianal lesions, and previous and current use of anti-TNF therapy. In contrast, use of vedolizumab increased among patients over age 60, with either L2 or B1 phenotypes with more than a 10-year duration of CD.

Physicians preferred use of anti-TNF medications (78.2% of cases) in patients naïve to any biological therapy, selecting infliximab (41.9%) and adalimumab (36.3%). Anti-TNF therapy remains the preferred first-line biological treatment for patients with CD.

“Physicians are more likely to use ustekinumab when anti-TNFs are contraindicated,” the study authors noted. “The choice of an alternative therapy to anti-TNFs trends more in favor of vedolizumab in cases of [CD] with an ulcerative colitis-like phenotype. Even in an unrestricted reimbursement setting, anti-TNFs remained the preferred first-line biological therapy choice of physicians except in cases with significant comorbidities.”

Study limitations included French reimbursement negatively influencing prescription of vedolizumab and ustekinumab, recruitment of patients and physicians only from tertiary academic centers, missing data from the survey, and lack of a validated methodology during development of the survey.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Amiot A, Seksik P, Reimund JM, et al. Prevalence of anti-TNF contraindications in Crohn’s disease: A cross-sectional survey from the GETAID. Dig Liver Dis. Published online May 14, 2022. doi:10.1016/j.dld.2022.04.011