Dose tailoring of anti‐tumour necrosis factor‐alpha therapy delivers useful clinical efficacy in Crohn disease patients experiencing loss of response. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Ghaly, S.; Costello, S.; Beswick, L.; Pudipeddi, A.; Agarwal, A.; Sechi, A.; Antoniades, S.; Headon, B.; Connor, S.; Lawrance, I. C.; Sparrow, M.; Walsh, A. J.; Andrews, J. M.; AIBDA
• Is Part Of: Internal medicine journal. Volume 45:Issue 2(2015)
• Page Start: 170
• Page End: 177
• Publication Date: 2015-02
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12621
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12621-sec-0001" sec-type="section"> <title>Background</title> <p>'Dose tailoring' of anti‐tumour necrosis factor alpha (TNF‐α) therapy in Crohn disease (CD), by dose escalation, or shortening of dosing intervals, has been suggested to regain clinical response following a flare in a proportion of patients. However, reported outcome data are sparse and none exists from Australia.</p> </sec> <sec id="imj12621-sec-0002" sec-type="section"> <title>Method</title> <p>In an observational multicentre, retrospective study, the impact of anti‐TNF‐α dose tailoring on corticosteroid use, the need for surgery and physician perception of clinical efficacy was examined in a real‐world setting at six Australian adult teaching hospitals. Demographics, disease characteristics, medications, indication for and duration of dose tailoring were documented.</p> </sec> <sec id="imj12621-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty‐five CD patients were identified as requiring dose tailoring and secondary loss of response was the indication in 96%. Either adalimumab (64%) or infliximab (36%) was dose escalated for a median of 5 months (range 1–47), with a median of 20 months follow up (range 3–65). At 3 months, dose tailoring reduced the mean number of days on high‐dose corticosteroids (45 vs 23, <italic>P</italic> = 0.01). Most (78%) patients remained resection free, and 73% of physicians reported good clinical efficacy of dose tailoring. Of those who de‐escalated therapy due to induction of remission, long‐term (>12 months) follow up and complete data on steroid use were available in 15/28, with 12/15 (80%) remaining steroid free at 1 year.</p> </sec> <sec id="imj12621-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Short‐term dose tailoring regains disease response in the majority of patients with CD. Of these, most will remain free of corticosteroids at 1 year after de‐escalating therapy.</p> </sec> </abstract>