Dose de-escalation to adalimumab 40 mg every three weeks in patients with inflammatory bowel disease-A multicenter, retrospective, observational study

Dig Liver Dis. 2019 Feb;51(2):236-241. doi: 10.1016/j.dld.2018.10.022. Epub 2018 Nov 8.

Abstract

Background: Data about the outcomes after adalimumab dose de-escalation in inflammatory bowel disease (IBD) are scarce.

Objectives: To assess the outcomes after adalimumab dose de-escalation, and to identify potential factors associated with failure.

Methods: Retrospective, observational study including all IBD patients who had undergone adalimumab dose de-escalation to 40 mg every three weeks across seven GETAID centers, between June 2011 and September 2017. Failure of adalimumab dose de-escalation was defined as the need for treatment re-escalation, discontinuation of adalimumab, or clinical, biochemical and/or morphologic disease relapse.

Results: Fifty-six patients were identified (n = 46 Crohn's disease, n = 10 ulcerative colitis). Median (IQR) duration of follow-up after adalimumab dose de-escalation was 15.9 (7.9-30.6) months. Adalimumab dose de-escalation was a failure in 21/56 (37.5%) patients and successful in 35/56 (62.5%) patients. Median (IQR) time until failure was 8.9 (4.6-15.6) months. At multivariate analysis, inactive disease at magnetic resonance imaging and/or endoscopy in the year before adalimumab dose de-escalation decreased the risk of failure with a factor five (P = 0.02).

Conclusions: Adalimumab dose de-escalation to 40 mg every three weeks is possible in almost two thirds of IBD patients. Objective morphologic signs of active disease should be ruled out before considering a de-escalation strategy with adalimumab.

Keywords: Adalimumab; Crohn’s disease; De-escalation; Inflammatory bowel disease; Ulcerative colitis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adalimumab* / administration & dosage
  • Adalimumab* / adverse effects
  • Adult
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Colitis, Ulcerative* / diagnosis
  • Colitis, Ulcerative* / drug therapy
  • Crohn Disease* / diagnosis
  • Crohn Disease* / drug therapy
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Monitoring / methods*
  • Endoscopy / methods
  • Female
  • Humans
  • Intestines / diagnostic imaging*
  • Magnetic Resonance Imaging / methods
  • Maintenance Chemotherapy / methods
  • Male
  • Middle Aged
  • Remission Induction / methods
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Adalimumab