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P489. How often is dose escalation needed in patients with inflammatory bowel disease treated with anti-TNF?

N. Viazis1, T. Koukouratos1, E. Saprikis1, M. Al-Odat1, E. Anastasopoulos1, G. Zacharakis1, D. Karamanolis1, 1Evangelismos Hospital, 2nd Department of Gastroenterology, Athens, Greece


The efficacy of anti tumor necrosis factor therapy in patients with inflammatory bowel disease has been demonstrated in several randomized clinical trials. However, some patients do not respond to standard dose and therapy needs to be intensified. The aim of our study was to evaluate how often is dose escalation needed in patients treated with infliximab or adalimumab for ulcerative colitis or Crohn's disease, in a tertiary hospital setting.


Analysis of our database, regarding inflammatory bowel disease patients currently receiving anti-TNF therapy for maintenance of remission. Standard dose of maintenance infliximab therapy was considered that of 5 mg/kg of body weight administered every 2 months and standard dose of adalimumab therapy was considered that of 40 mg administered every 2 weeks.


As of September 2011, a total of 132 patients have been receiving infliximab (n = 77) or adalimumb (n = 55) therapy in our Department. From those patients, 113 are being treated for Crohn's disease and 19 for ulcerative colitis. Among them, 101 (76.5%) are receiving the standard dosage regimen, 13 (9.8%) are receiving double infliximab dose (10 mg/kg of body weight) every two months, 5 (3.8%) are receiving double infliximab dose every one and a half or one month and 13 (9.8%) are receiving the standard adalimumab dose every week. Therefore, a total of 31 patients (23.5%) needed a dose escalation for maintenance of remission of their disease. From these patients, 30 have been treated for Crohn's disease and 1 for ulcerative colitis. The patient with ulcerative colitis had pancolitis, while from those with Crohn's disease, 18 had ileocolonic, 7 had colonic and 5 had ileal disease. It is of note that from the 30 patients with Crohn's disease, 16 had perianal disease as well. The vast majority of patients that needed a dose escalation are now in clinical remission (n = 25, 80.6%) without any other intervention, while in 3 patients methotrexate had been added, 2 had been operated for their disease and 1 entered a clinical trial investigating a new drug.


A substantial number of inflammatory bowel disease patients treated with anti-TNF will need a dose escalation for maintaining remission of the disease.