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Journal of Crohn's and Colitis: 9 (5)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients

Filip Baert , Elien Glorieus , Cathérine Reenaers , Geert D'Haens , Harald Peeters , Dennis Franchimont , Olivier Dewit , Philippe Caenepeel , Edouard Louis , Gert Van Assche ,
DOI: http://dx.doi.org/10.1016/j.crohns.2012.03.018 154-160 First published online: 1 March 2013

Abstract

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.

Keywords
  • Adalimumab
  • Dose escalation
  • Dose de-escalation
  • Crohn's disease
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