Lieven Pouillon1, Anne Lamoureux2, Guillaume Pineton de Chambrun3, Lucine Vuitton4, Benjamin Pariente5, Camille Zallot2, Gaspard Dufour3, Mathurin Fumery6, Cédric Baumann7, Aurélien Amiot8, Stéphane Nancey9, Hélène Rousseau7, Laurent Peyrin-Biroulet10. 1. INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France; Imelda GI Clinical Research Center, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. 2. INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. 3. Department of Gastroenterology and Hepatology, Saint-Eloi Hospital, Montpellier University, Montpellier, France. 4. Department of Gastroenterology, University Hospital of Besançon, Besançon, France. 5. Department of Hepato-Gastroenterology, Claude Huriez Hospital, University of Lille-II, Lille, France. 6. Department of Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France. 7. Clinical Research Support Facility PARC, UMDS, Nancy University Hospital, Vandoeuvre-lès-Nancy, France. 8. Department of Gastroenterology, Henri Mondor Hospital, Paris-Est Cretain Val-de-Marne University (UPEC), Créteil, France. 9. Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre Bénite, France; INSERM U1111 and International Center for Research in Infectiology, Lyon, France. 10. INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. Electronic address: peyrinbiroulet@gmail.com.
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.
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.
Authors: Marleen Bouhuys; Willem S Lexmond; Gerard Dijkstra; Triana Lobatón; Edouard Louis; Stephanie van Biervliet; Henk Groen; Jordi Guardiola; Patrick van Rheenen Journal: BMJ Open Date: 2021-11-03 Impact factor: 2.692
Authors: L J T Smits; R W M Pauwels; W Kievit; D J de Jong; A C de Vries; F Hoentjen; C J van der Woude Journal: BMJ Open Date: 2020-05-26 Impact factor: 2.692