Rationale for Correct Answer

The correct answer is: Consider an alternative to an anti-TNF-α, or prescribe it concomitantly with an immunomodulator

The 2020 PANTS study found that the human leukocyte antigen (HLA) variant HLA-DQA1*05 is associated with production of antibodies against infliximab and adalimumab.1 This result was not confirmed in a subsequent study,2 and a separate study found no correlation between HLA-DQA1*05 and anti-TNF-α primary or secondary nonresponse.3 Until the relationship between this variant and treatment response is further elucidated, knowledge about its presence can influence the clinician to prescribe a different therapy or prescribe it concomitantly with an immunomodulator. HLA-DQA1*05 not associated with clinical response to ustekinumab and vedolizumab.4 Currently, the use of biomarkers for precision medicine for IBD has little practical application in clinical practice.5-7 There are insufficient data to establish clear connections with drug response. Furthermore, testing can be prohibitively expensive or time-consuming.

1. Sazonovs A et al. Gastroenterology. 2020;158(1):189-99;
2. Spencer EA et al. Gastroenterology. 2022;162(6):1746-48.e3;
3. Pascual-Oliver A et al. Inflamm Bowel Dis. 2023;izad130;
4. Navajas Hernández et al. Rev Esp Enferm Dig. 2023;10.17235/reed.2023.9491/2023;
5. Elhag DA et al. Int J Mol Sci. 2022;23(13):6966;
6. Marafini I et al. Front Pharmacol. 2021;12:653924;
7. Barnes EL et al. Gastroenterology. 2021;160(3):677-89.