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P166. Efficacy of intensification regimes of biologic therapy in patients with inflammatory bowel disease and secondary non-response: Experience of a single referral centre

M. Lukáš, D. Ďuricová, M. Bortlík, N. Machková, V. Komárek, E. Bouzková

IBD Clinical and Research Centre ISCARE and 1st Medical Faculty, Charles University, Prague, Czech Republic

Aim: In patients with inflammatory bowel disease (IBD) secondary loss of response to infliximab or adalimumab has been reported between 11% and 48% and constitutes a significant problem in daily clinical practice. Therapy intensification with interval shortening and/or dose increase has been recommended to regain clinical response. The objective of this study was to evaluate the efficacy of intensification regimes of infliximab and adalimumab in patients with IBD with regard to therapeutic response and ability to return to normal dosing.

Material and Methods: All patients with IBD treated in our centre with infliximab or adalimumab between October 2007 and September 2010 were retrospectively reviewed for intensification of therapeutic regimes of biological therapy. Data on start and type of the intervention, response to intervention, ability to return to standard dosing regimen and other details on biological therapy were retrieved from patients' medical files.

Results: Totally, 341 courses of infliximab therapy and 111 courses of adalimumab therapy were administered during the study period. Intensification was performed during 47 (14%) infliximab courses (25 in patients with Crohn's disease, 21 with ulcerative colitis and 1 patient with indeterminate colitis) and 14 (13%) adalimumab courses (12 in patients with Crohn's disease and 2 with ulcerative colitis). In infliximab, interval shortening was performed in 33 (70%) cases, dose increase in 6 (13%) and both types of intervention in 8 (17%) treatment courses. In adalimumab therapy only interval shortening to every week was used. The median time to intervention since biological therapy start was 6 months (range 3–21) in infliximab and 3 months (1–7) in adalimumab treatment. The median follow-up after intensification start was 16 months (1–46). In infliximab group, interval shortening led to clinical response in 22/33 (67%) courses, dose increase in 2/6 (33%) courses and in both interventions response was observed in 4/8 (50%) cases. In adalimumab, shortening of interval was effective in 5/14 (36%) cases. Return to normal dosing was possible in half of infliximab courses responding to shortening of interval and combined intervention and in both cases with dose increase. In adalimumab group, 40% of courses obtaining clinical response returned to normal dosing every other week.

Conclusion: Intensification of biological therapy restored clinical response in 54% of therapeutic interventions, with shortening of interval in infliximab treatment being the most effective. Approximately in half of the cases the normal dosing regime was possible to restore.