Adalimumab dose de-escalation possible in most IBD patients
Dose de-escalation of adalimumab to 40 mg every 3 weeks is possible in most of the patients with inflammatory bowel disease (IBD), a recent study has shown.
Researchers conducted a retrospective observational study of 56 IBD patients (median age at diagnosis, 25 years; 44.6 percent male) whose adalimumab doses were de-escalated to 40 mg. De-escalation failure was defined as the need for re-escalation, discontinuation of adalimumab treatment, or biochemical, morphological or clinical disease relapse.
Of the patients, 10 had ulcerative colitis while the remaining 46 had Crohn’s disease. The median time on adalimumab medication before de-escalation was 36 months. At the moment of de-escalation, all of the participants were in clinical remission while most (89.3 percent; n=28) were in biochemical remission.
In more than a third of the cases (37.5 percent; n=21), dose de-escalation was a failure, the median time to which was 8.9 years. In this subgroup of patients, 18 (85.7 percent) underwent dose re-escalation due to insufficient disease control. Seventeen of these patients remained on adalimumab medication at the end of the study duration.
In comparison, two-thirds (62.5 percent; n=35) of the participants successfully underwent dose de-escalation, nine of whom eventually stopped adalimumab medication due to deep remission.
Multivariate Cox analysis showed that the only factor significantly correlated with the risk of failure was having an inactive disease on magnetic resonance imaging and/or endoscopy in the year prior to adalimumab de-escalation (hazard ratio, 0.2; 95 percent CI, 0.1–0.8; p=0.02).