Dose-escalated biologic therapy improves outcomes in people with inflammatory bowel disease

Biologic therapies are effective in inflammatory bowel disease (IBD), yet many people do not achieve adequate or sustained response to standard dosing, which necessitates dose escalation (DE).

To examine the need for DE and subsequent outcomes in a large real-world cohort.

Crohn's colitis care (CCCare) is an electronic medical record used in Australasia. Data flow into a de-identified clinical quality registry (CQR), which was interrogated in November 2024. DE was defined as maintenance dosing exceeding the standard average daily dose. We examined data before and over 12 months following DE.

Of 6093 courses of biologic therapy, 37.3% (n = 2272) were DE therapy. Most were for Crohn's disease (n = 4208, 69.1%); median time from initiating therapy to DE was 5 months (IQR: 0-19), and 74.2% (n = 1685) remained on DE therapy beyond 12 months. Twelve months post DE, significant increases in remission rates were seen as assessed by faecal calprotectin <250 μg/g (28.1% increase, P < 0.001), patient-reported outcomes (PRO2) (20.2% increase, P < 0.001) and endoscopy (5.4% increase, P < 0.001). Healthcare utilisation (HCU) was reduced with fewer endoscopies (37% reduction, P < 0.001), radiology investigations (22.9% reduction, P < 0.001) and hospital admissions (39% reduction, P = 0.91).

DE therapy in real-world care is effective and common, improving remission rates and reducing HCU. The lack of formal funding for DE therapy in Australasia appears likely to cause delayed or inadequate disease control, contributing to avoidable morbidity and costs.