Year 2019 / Volume 111 / Number 11
Original
Differences in the need for adalimumab dose optimization between Crohn’s disease and ulcerative colitis

846-851

DOI: 10.17235/reed.2019.6148/2018

David Olivares, Cristina Alba, Irene Pérez, Valentín Roales, Enrique Rey, Carlos Taxonera,

Abstract
Aim: to compare the need for and time to adalimumab dose escalation and de-escalation between patients with Crohn’s disease (CD) and ulcerative colitis (UC). Methods: this observational cohort study included patients with luminal CD or patients with UC treated with adalimumab. Adalimumab dose optimization was decided based on the Harvey-Bradshaw index (CD) or the partial Mayo score (UC). The co-primary endpoints were the differences in the rate of dose escalation and the cumulative probability of escalation-free survival between cohorts. We also evaluated the rates of de-escalation and predictors of adalimumab dose escalation and de-escalation. Results: twenty-four of 43 CD patients (56%) and 28 of 43 UC patients (65%) required adalimumab dose escalation. UC patients had a higher adjusted rate of dose escalation (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.19-4.56; p = 0.013) than CD patients. The median time to dose escalation was significantly shorter for UC than CD patients (3.2 months, interquartile range [IQR]: 2.0-10.3 vs 12.2 months, IQR: 6.1-35.7; p = 0.001). Survival curves showed that UC patients had an increased probability of dose escalation (p < 0.001). Prior anti-TNF therapy was associated with dose escalation (HR 2.13, 95% CI 1.05-4.34; p = 0.037). Adalimumab dose de-escalation was attempted in 32% of UC patients and 50% of CD patients. Survival curves showed that CD patients had an increased probability of dose de-escalation (p = 0.030). Conclusion: UC patients more frequently required adalimumab dose escalation than CD patients. UC patients required optimization earlier than CD patients. More CD patients than UC patients can be dose de-escalated later on during treatment.
Share Button
New comment
Comments
No comments for this article
References
1. Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology. 2007; 132: 52-65.
2. Sandborn WJ, van Assche G, Reinisch W, et al. Adalimumab induces and maintains clinical remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2012; 142: 257-265.
3. Sandborn WJ, Colombel JF, Schreiber S, et al. Dosage adjustment during long-term adalimumab treatment for Crohn's disease: clinical efficacy and pharmacoeconomics. Inflamm Bowel Dis. 2011; 17: 141-151.
4. Wolf D, D'Haens G, Sandborn WJ, et al. Escalation to weekly dosing recaptures response in adalimumab-treated patients with moderately to severely active ulcerative colitis. Aliment Pharmacol Ther. 2014; 40: 486-497.
5. Billioud V, Sandborn WJ, Peyrin-Biroulet L. Loss of response and need for adalimumab dose intensification in Crohn's disease: a systematic review. Am J Gastroenterol. 2011; 106: 674-684.
6. Black CM, Yu E, McCann E, et al. Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data. PLoS One. 2016; 11: e0149692.
7. Taxonera C, Iglesias E, Muñoz F, et al. Adalimumab Maintenance Treatment in Ulcerative Colitis: Outcomes by Prior Anti-TNF Use and Efficacy of Dose Escalation. Dig Dis Sci. 2017; 62: 481-490.
8. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19 (Suppl A): 5–36.
9. Reinisch W, Sandborn WJ, Hommes DW, et al. Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011; 60: 780-787.
10. Iborra M, Pérez-Gisbert J, Bosca-Watts MM, et al. Effectiveness of adalimumab for the treatment of ulcerative colitis in clinical practice: comparison between anti-tumour necrosis factor-naïve and non-naïve patients. J Gastroenterol. 2017; 52: 788-799.
11. Taxonera C, Olivares D, Mendoza JL, et al. Need for infliximab dose intensification in Crohn's disease and ulcerative colitis. World J Gastroenterol. 2014; 20: 9170-9177.
12. O'Donnell S, Stempak JM, Steinhart AH, et al. Higher Rates of Dose Optimisation for Infliximab Responders in Ulcerative Colitis than in Crohn's disease. J Crohns Colitis. 2015; 9: 830-836.
13. Bosca-Watts MM, Cortes X, Iborra M, et al. Short-term effectiveness of golimumab for ulcerative colitis: Observational multicenter study. World J Gastroenterol. 2016; 22: 10432-10439.
14. Taxonera C, Rodríguez C, Bertoletti F, et al. Clinical Outcomes of Golimumab as First, Second or Third Anti-TNF Agent in Patients with Moderate-to-Severe Ulcerative Colitis. Inflamm Bowel Dis. 2017; 23: 1394-1402.
15. Bossuyt P, Baert F, D'Heygere F, et al. Early Mucosal Healing Predicts Favorable Outcomes in Patients With Moderate to Severe Ulcerative Colitis Treated With Golimumab: Data From the Real-life BE-SMART Cohort. Inflamm Bowel Dis. 2018 Jun 15. doi: 10.1093/ibd/izy219. [Epub ahead of print]
16. Vermeire S, Gils A, Accossato P, et al. Immunogenicity of biologics in inflammatory bowel disease. Therap Adv Gastroenterol. 2018; 11: 1756283X17750355. doi: 10.1177/1756283X17750355. eCollection 2018.
17. Kevans D, Murthy S, Mould DR, et al. Accelerated Clearance of Infliximab is Associated With Treatment Failure in Patients With Corticosteroid-Refractory Acute Ulcerative Colitis. J Crohns Colitis. 2018; 12: 662-669.
18. Yarur AJ, Abreu MT, Deshpande AR, et al. Therapeutic drug monitoring in patients with inflammatory bowel disease. World J Gastroenterol. 2014; 20: 3475-3484.
19. Brandse JF, van den Brink GR, Wildenberg ME, et al. Loss of Infliximab Into Feces Is Associated With Lack of Response to Therapy in Patients With Severe Ulcerative Colitis. Gastroenterology. 2015; 149: 350-355.
20. Baert F, Glorieus E, Reenaers C, et al. Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients. J Crohns Colitis. 2013; 7: 154-160.
21. Van de Vondel S, Baert F, Vanden Branden S, et al. Incidence and Predictors of Success of Adalimumab Dose Escalation and De-escalation in Ulcerative Colitis: a Real-World Belgian Cohort Study. Inflamm Bowel Dis. 2018; 24: 1099-1105.
22. Baert F, Vande Casteele N, Tops S, et al. Prior response to infliximab and early serum drug concentrations predict effects of adalimumab in ulcerative colitis. Aliment Pharmacol Ther. 2014; 40: 1324-32.
Related articles

Letter

Treatment with hyperbaric oxygen in a Crohn’s disease patient

DOI: 10.17235/reed.2024.10166/2023

Letter

Coincidental oral lesions in Crohn’s disease

DOI: 10.17235/reed.2023.9992/2023

Letter

Tofacitinib-induced eosinophilia

DOI: 10.17235/reed.2023.9831/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Letter

Perianal Paget’s disease

DOI: 10.17235/reed.2022.9304/2022

Letter

Chinese dragon sign of ulcerative colitis

DOI: 10.17235/reed.2022.9154/2022

Letter

Ulcerative colitis exacerbated by strongyloidiasis

DOI: 10.17235/reed.2022.9044/2022

Digestive Diseases Image

Peristomal cutaneous Crohn's disease by contiguity

DOI: 10.17235/reed.2022.8909/2022

Review

Clinical settings with tofacitinib in ulcerative colitis

DOI: 10.17235/reed.2022.8660/2022

Letter

Mesalazine induced interstitial pneumonitis in the COVID era

DOI: 10.17235/reed.2022.8635/2021

Letter

Anal neoplasia and perianal Crohn’s disease: myth or reality?

DOI: 10.17235/reed.2021.8317/2021

Letter

The effect of Adacolumn® on ulcerative colitis with COVID-19

DOI: 10.17235/reed.2020.7156/2020

Letter

Sweet syndrome in severe ulcerative flare

DOI: 10.17235/reed.2020.6995/2020

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Letter to the Editor

Ulcerative colitis with gastric and duodenal involvement

DOI: 10.17235/reed.2017.4685/2016

Editorial

Specialist care in the management of inflammatory bowel disease

DOI: 10.17235/reed.2016.4628/2016

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Case Report

Mesalamine-induced myopericarditis - A case report

DOI: 10.17235/reed.2016.4016/2015

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Citation tools
Olivares D, Alba C, Pérez I, Roales V, Rey E, Taxonera C, et all. Differences in the need for adalimumab dose optimization between Crohn’s disease and ulcerative colitis. 6148/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1087 visits.
This article has been downloaded 228 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 28/12/2018

Accepted: 19/05/2019

Online First: 30/09/2019

Published: 07/11/2019

Article revision time: 131 days

Article Online First time: 276 days

Article editing time: 314 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology