Success of Adalimumab Dose Escalation & De-Escalation in Ulcerative Colitis

Guest: Shail M. Govani, MD, MSc
Incidence and Predictors of Success of Adalimumab Dose Escalation and De-escalation in Ulcerative Colitis: a Real-World Belgian Cohort Study. Saartje Van de Vondel, MD, Filip Baert, MD, PhD, Christine Reenaers, MD, PhD, Stijn Vanden Branden, MD, Leila Amininejad, MD, Pieter Dewint, MD, PhD, Wouter Van Moerkercke, MD, Jean-François Rahier, MD, PhD, Pieter Hindryckx, MD, PhD, Peter Bossuyt, MD, Marc Ferrante, MD, PhD, and Belgian IBD Research and Development (BIRD) BACKGROUND: Adalimumab (ADM) has been shown efficacious in ulcerative colitis (UC). In randomized controlled trials, dose escalation from 40 mg ADM every other week to 40 mg every week was required in 20%–25% of patients within 1 year. Real-life data suggest higher escalation rates. Attempts for dose de-escalation have not been studied yet. We assessed the need for, outcome of, and predictors of dose escalation and de-escalation in a large retrospective cohort of UC patients treated with ADM. METHODS: We included 231 consecutive patients from 10 Belgian centers initiating ADM treatment for active UC before September 1, 2015 (follow-up ≥1 year in each patient). We performed detailed chart review to identify variables associated with short-term clinical benefit (based on physician global assessment and absence of rectal bleeding at week 10), success …