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P514. Efficacy of dose intensification of anti-TNF therapy in Crohn's disease – single center experience

Z. Szepes1, K. Farkas1, M. Szücs2, F. Nagy1, A. Bálint1, T. Wittmann1, T. Molnár1, 1University of Szeged, First Department of Medicine, Szeged, Hungary, 2University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary

Background

Intensification of biological therapy is recommended in case of loss of response in patients treated with tumor necrosis factor (TNF) alpha blockers. Dose escalation is performed by dose increase in case of infliximab and change to weekly dosing in case of adalimumab. The aim of this study was to assess the outcome of dose intensification in Crohn's disease (CD) patients who lost efficacy to infliximab or adalimumab therapy.

Methods

We performed a retrospective survey of patients with CD who had been treated with biologicals for at least one year period, and whose treatment had to be intensified due to loss of response. We analyzed the efficacy of the intensified regimen.

Results

Twenty-nine patients were included. Twelve of them were on infliximab, 17 on adalimumab therapy. Eleven of the 17 adalimumab-treated patients received infliximab previously. After dose escalation 10.3% of the patients showed clinical response and 24.1% achieved remission. 34.5% did not show any effect. Further 27.5% underwent surgery (bowel resection, colectomy or abscess drainage). One patient had allergic reaction, 8 patients developed side effects after dose intensification. The follow up period was 22 months. Dose intensification was significantly more common in patients previously treated with biological therapy (p = 0.009) and in case of concomitant use of immunomodulators (p = 0.003). Elevated erythrocyte sedimentation rate, C-reactive protein and leukocytosis at week 12th also associated with the need of dose intensification. There was no significant difference in the frequency of side effects after dose escalation.

Conclusion

Dose intensification can result remission or clinical response in one third of CD patients. Previous biological therapy, concomitant use of immunomodulators and elevated inflammatory laboratory parameters at week 12th predispose to the need of dose intensification. Surgical interventions are very frequent among non-responder cases suggesting the causative role of stenosis or abscess in non-response.