Adalimumab Concentration Changes After Dose Escalation in Inflammatory Bowel Disease

Area of Science:

• Pharmacology
• Gastroenterology
• Immunology

Background:

• Dose escalation of adalimumab (ADA) is common for inflammatory bowel disease (IBD) patients experiencing loss of response.
• Achieving a target serum ADA concentration of 12 mcg/mL is linked to improved outcomes.
• Data on the efficacy of dose escalation to reach target ADA concentrations are limited.

Purpose of the Study:

• To determine the expected change in serum ADA concentration after dose escalation in IBD patients.
• To evaluate the ability of dose escalation to achieve a target ADA concentration of ≥12 mcg/mL.
• To identify predictors for achieving target ADA concentrations.

Main Methods:

• Retrospective cohort study of IBD patients treated with ADA.
• Patients categorized into q14-day dosing, q7-day dosing, and dose escalation (q14 to q7 days) groups.
• Multiple logistic regression used to identify predictors of achieving target ADA concentration.

Main Results:

• Dose escalation resulted in a mean ADA increase of 5.5 mcg/mL (P < 0.0001).
• A significant proportion of escalated patients achieved ADA ≥12 mcg/mL (P = 0.0019) and clinical remission (P = 0.0053).
• Predictors for achieving target ADA included age <46, BMI <29, and initial ADA ≥3.0 mcg/mL.

Conclusions:

• Dose escalation from q14 to q7 days is expected to increase serum ADA by 5.5 mcg/mL.
• Initial ADA concentration, age, and BMI are factors influencing the achievement of target ADA levels post-escalation.