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Management of secondary anti-TNF non-responders


Sunanda V. Kane, MD
Professor of Medicine
Mayo Clinic College of Medicine
Mayo Clinic
Rochester, MN



Using a secondary non-responder to anti-TNF therapy, this case consult will discuss some of the key management challenges that might be encountered. It will also focus on decision-making and factors to consider, including dose optimization, switching within class, and switching out of class.

This activity has been designed to meet the educational needs of gastroenterologists and registered nurses involved in the care of patients with inflammatory bowel disease (IBD).

Release date: October 30, 2015

Learning objectives

After completing this activity, the participant should be better able to:

  • Discuss the value of objective criteria for active inflammation for treatment decisions
  • Describe the role of serum drug levels and when they are useful
  • Develop an algorithm for patients with a secondary loss of response to their first anti-TNF agent
  • Provide appropriate care and counsel for patients and their families.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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