In patients with UC treated with anti-TNF (adalimumab or infliximab), does timing of initiation relative to disease activity affect clinical remission at one year

What is known

- In ULTRA, patients with higher Mayo scores, higher CRP, and higher baseline weight had reduced adalimumab remission rates. ¹ - Primary non-response to infliximab occurred in roughly 22–35% of patients, and primary non-responders were at high risk of colectomy. ² - Predictors of infliximab non-response included low hemoglobin (<9.4 g/dL) and more than eight bowel movements per day. ²

What is unknown / caveats

- Excerpts report baseline severity as a predictor of remission, not the timing of initiation as an intervention - No study directly stratifies one-year remission by early versus late initiation - Whether earlier initiation at lower activity independently improves one-year remission cannot be established from these excerpts.

## References

1. Fausel R, Afzali A. Biologics in the management of ulcerative colitis - comparative safety and efficacy of TNF-α antagonists. Ther Clin Risk Manag. 2015. PMID: 25609972.

2. Hoentjen F, Sakuraba A, Hanauer S. Update on the management of ulcerative colitis. Curr Gastroenterol Rep. 2011;13:475-85. PMID: 21789495.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._