Inflammatory bowel diseases (IBD) are prevalent in Western countries. In North America and Europe, over 1.5 million and 2 million people suffer from the disease, respectively.1 In newly industrialized countries (NICs), IBD incidence and prevalence is lower; however, recent studies describe increasing rates including Latin America (LATAM).2, 3 Main reasons for this epidemiological trend may include socioeconomic (environmental changes, urbanization, lifestyle modifications) as well as health-care related factors (increased IBD awareness).2

Anti-tumor necrosis factor (anti-TNF) agents were introduced during early 2000s for IBD treatment.4 These molecules have been shown to be effective both in inducing and maintaining remission in patients with moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). Nevertheless, up to 22% of UC patients and 31% of CD patients are considered primary non-responders (PNR) to anti-TNF induction therapy. Furthermore, it has been estimated that 49%–59% of UC and 23%–64% of CD patients lose response to anti-TNF agents over time (secondary loss of response [SLOR]).5, 6 As a consequence, UC and CD patients receiving anti-TNF agents may require dose optimization (escalation of dose and/or frequency of administration), treatment discontinuation or initiation of another biologic agent (switching or class swapping), augmentation of concurrent non-biologic therapy, or surgery. All these strategies are considered as indicators of suboptimal response to anti-TNF therapy.7, 8

Since the epidemiology and clinical patterns of IBD differ between different countries and communities, the response to drugs could also be different due to several reasons, including microbiota, genetics and different treatment patterns.9, 10 Data on anti-TNF treatment patterns and suboptimal response among IBD patients in LATAM are scarce. The EXPLORE study aimed to describe the incidence and indicators of suboptimal response to anti-TNF therapy in UC and CD patients in the clinical setting in NICs, including Asia-Pacific, LATAM, Russia and the Middle East regions.11 This study showed that suboptimal response to anti-TNF agents is common in IBD patients residing in NICs, but differences were reported across the regions.

We conducted a sub-analysis of the EXPLORE study in LATAM countries, with a focus on real-world suboptimal response of IBD patients to a first anti-TNF agent, diagnosis journey, barriers to anti-TNF prescription, local treatment pathways and other aspects specific to the region, such as the prevalence of opportunistic infections, especially TB.