Adalimumab, at an induction dose of 160/80 mg followed by 40 mg every other week is approved for treatment of refractory Crohn's disease and for patients with loss of response to infliximab.
Dr Swaminath and colleagues from New York, USA evaluated the indications for adalimumab to identify whether this strategy is effective in inducing or maintaining remission.
In addition, the team assessed the proportion of inflammatory bowel disease patients who require dose escalation.
Patients prescribed adalimumab for Crohn’s disease were identified and included for analysis, if they had follow-up of at least 6 weeks.
Adalimumab dose was escalated if patients had return of symptoms prior to next dose.
The team used clinical judgment to determine severity of disease.
|Adalimumab dose escalation occurred in 29%|
|Alimentary Pharmacology & Therapeutics|
A second GI physician confirmed disease severity as determined by the first physician.
The team reported that a total of 48 out of 60 patients met inclusion criteria.
Adalimumab was used to treat Crohn’s disease in 98%, and ulcerative colitis in 2% of patients.
The research team noted that most patients had moderate or severe disease.
The team found that prior infliximab exposure was present in 88%.
Adalimumab dose escalation occurred in 29% within an average time of 2 months.
Of the majority of patients who required dose escalation, 64% did not improve clinically.
The team observed that steroids could be discontinued in three of 19%.
Clinical improvement was noted in 44%, and 2% of patients achieved clinical remission.
The team noted that adverse drug reactions necessitated drug discontinuation in 8% of patients.
Dr Swaminath’s team concludes, “This retrospective review from a single academic medical center suggests that a minority of patients, who cannot be maintained on 40 mg every other week, of adalimumab benefit from an increased dose.”
“This suggests the need for a treatment with an alternative mode of action in anti-tumor necrosis factor failures.