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

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• 作者：Nicolas Duveau ; Maria Nachury ; Romain Gerard ; Julien Branche ; Vincent Maunoury ; Medina Boualit ; Pauline Wils ; Pierre Desreumaux ; Benjamin Pariente ; ^{benjamin.pariente@chru-lille.fr}
• 关键词：Anti-TNF ; Optimization ; Therapeutic strategy
• 刊名：Digestive and Liver Disease
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：49
• 期：2
• 页码：163-169
• 全文大小：612 K
• 卷排序：49

文摘

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.MethodsWe 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.ResultsA 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 Adalimumab was withdrawn in 4 patients due to side effects.ConclusionsAdalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss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.