Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients.
(2013) Journal of Crohn’s and Colitis — Vol. 7, n° 2, p. 154-160 (2013)
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- BACKGROUND AND AIMS: Adalimumab is efficacious in inducing and maintaining remission in Crohn's disease but dose escalation is needed in 30-40% after 1 year. Attempts for dose de-escalation have not been studied. This study aimed to assess the need for, predictors, and outcome of dose escalation and de-escalation in a large cohort of adalimumab treated Crohn's patients. METHODS: All consecutive patients treated with open label adalimumab for active Crohn's disease from the participating centres were included in this cohort study. A detailed retrospective chart review was performed to look for possible factors predicting outcome. RESULTS: Eighty four percent of 720 patients had a primary response and were followed up for a median of 14 months. Thirty four percent needed escalation after a median of 7 months (0-55 months). Multivariate predictors for dose escalation were the following: prior anti-TNF use (p<0.0001), no concomitant azathioprine or <3 m (p<0.02) and abnormal CRP at start (p<0.05). Dose escalation re-induced response for at least 6 months in 67%. Only abnormal CRP at start correlated with failure of dose escalation (p=0.02). Dose de-escalation was attempted in 54% and was successful in 63%. After a median follow-up of 14 m adalimumab was discontinued in 29% of patients. CONCLUSION: In this study real life nationwide cohort of Crohn's patients treated with adalimumab dose escalation was needed in 34% and was successful in 67%. Dose de-escalation was attempted in 54% and was successful in 63%. Overall 71% of patients maintained long term response on adalimumab.
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Baert, F., Glorieus, E., Reenaers, C., D’Haens, G., Peeters, H., Franchimont, D., Dewit, O., Caenepeel, P., Louis, E., & Van Assche, G. (2013). Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn’s patients. Journal of Crohn’s and Colitis, 7(2), 154-160. https://doi.org/10.1016/j.crohns.2012.03.018 (Original work published 2013)