Journal of Crohn's and Colitis (2013) 7, 154-160

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 for BIRD (Belgian IBD Research and Development)

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 (pb0.0001), no concomitant azathioprine or b3 m (pb0.02) and abnormal CRP at start (pb0.05).
 
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.