Dose escalation for secondary loss of response in inflammatory bowel disease: 3-year outcomes and treatment persistence

Dose escalation of biologic therapies is commonly used to manage secondary loss of response in inflammatory bowel disease, although long-term real-world outcomes remain limited.

To evaluate long-term clinical outcomes and treatment persistence following biologic dose escalation for secondary loss of response in inflammatory bowel disease.

We conducted a retrospective cohort study of patients with inflammatory bowel disease who underwent dose escalation of infliximab, adalimumab or vedolizumab at a tertiary referral centre between 2018 and 2024. Outcomes included clinical disease activity scores, biochemical markers and treatment persistence, assessed at 3-12 months and annually up to 36 months following escalation.

A total of 155 patients were included (median age 31 years; 46% female), of whom 76% had Crohn's disease. A total of 89 patients received infliximab, 48 adalimumab and 18 vedolizumab. Dose escalation was undertaken for secondary loss of response in 68% and low drug concentrations in 42%. Infliximab escalation was associated with improvement in disease activity scores at 3 months, sustained to 36 months, with reductions in C-reactive protein across follow-up. Adalimumab escalation improved Harvey-Bradshaw Index at 3, 12 and 24 months, with reduction in faecal calprotectin at 3 months. Vedolizumab escalation improved Simple Clinical Colitis Activity Index at 3 months only. Treatment persistence at 36 months was 58% for infliximab, 65% for adalimumab and 73% for vedolizumab. Nine patients experienced minor adverse events.

Biologic dose escalation was associated with improvement in disease activity and modest treatment persistence following secondary loss of response in inflammatory bowel disease.