Differences in the need for adalimumab dose optimization between Crohn's disease and ulcerative colitis
David Olivares1, Cristina Alba1, Irene Pérez2
1Aparato Digestivo , Hospital Clínico San Carlos , España.
Revista Espanola De Enfermedades Digestivas
|October 1, 2019
Summary
Ulcerative colitis patients more often require adalimumab dose escalation sooner than Crohn's disease patients. However, Crohn's disease patients are more likely to undergo dose de-escalation.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Adalimumab is a biologic therapy used for inflammatory bowel diseases.
- Dose optimization is crucial for managing Crohn's disease (CD) and ulcerative colitis (UC).
Purpose of the Study:
- To compare the need for and timing of adalimumab dose escalation and de-escalation in CD versus UC patients.
Main Methods:
- An observational cohort study included CD and UC patients treated with adalimumab.
- Dose optimization was guided by disease-specific indices (Harvey-Bradshaw for CD, partial Mayo for UC).
- Co-primary endpoints included rates of dose escalation and escalation-free survival.
Main Results:
- 65% of UC patients and 56% of CD patients required dose escalation.
- UC patients had a higher rate (HR 2.33) and shorter time to escalation (median 3.2 vs 12.2 months) compared to CD patients.
- Prior anti-TNF therapy predicted escalation. De-escalation was more frequent in CD patients (50% vs 32% in UC).
Conclusions:
- Ulcerative colitis patients necessitate adalimumab dose escalation more frequently and earlier than Crohn's disease patients.
- Crohn's disease patients demonstrate a higher likelihood of successful dose de-escalation later in treatment.
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