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Adalimumab dose escalation is effective and well tolerated in Crohn’s disease patients with secondary loss of response to adalimumab

Nicolas Duveau, Maria Nachury, Romain Gerard, Julien Branche, Vincent Maunoury, Medina Boualit, Pauline Wils, Pierre Desreumaux, Benjamin Pariente

Abstract

Background

Although adalimumab is effective in Crohn’s disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn’s disease patients with a secondary loss of response.

Methods

We performed a retrospective and observational study including all Crohn’s disease patients who underwent dose escalation of adalimumab after a secondary loss of response from 2007 to 2015.

Results

A clinical response was observed in 99/124 (79%) patients at 3 months and in 62/107 (61%) patients at 12 months. The predictive factors of response to ADA dose escalation at 12 months on multivariate analysis were: maintenance therapy of 40 mg every week rather than 80 mg every other week (OR 3.64, 95% CI: 1.28–10.37) and a CRP level ≤ 5 mg/L at adalimumab dose escalation (OR 6.64, 95% CI: 1.40–27.53). Adalimumab was withdrawn in 4 patients due to side effects.

Conclusions

Adalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss of response. A 40 mg every week optimized regimen was predictive of a response to ADA dose escalation.

Keywords

  • Anti-TNF
  • Optimization
  • Therapeutic strategy