P439. In patients with Crohn's disease, timing of switching from infliximab to adalimumab affects prognosis
K. Takeuchi, A. Yamada, Y. Suzuki, Toho University, Sakura Medical Centre, Division of Gastroenterology, Department of Internal Medicine, Sakura, Japan
Patients with Crohn's disease (CD) under infliximab (IFX) maintenance therapy, at some time point may require dose escalation or shortening of infusion interval to maintain an adequate efficacy level due to loss of response. Switching from IFX to adalimumab (ADA) has been considered as one therapeutic option for avoiding adverse side effects and overcoming the loss of response phenomena, but hitherto, the most appropriate time point for this change over has not been reported. With this in mind, we became interested to determine a clinically relevant timing of switching from IFX to ADA in CD patients who had developed active disease in spite of IFX dose escalation or shortened infusion interval.
In this endeavour, we retrospectively reviewed CD patients who had received either IFX dose escalation/shortened infusion interval or switched from IFX at 5 mg/kg/bodyweight to ADA. All patients had developed active CD while under IFX maintenance therapy at 5 mg/kg/bodyweight. Patients were divided into switch group and IFX dose escalation group (IFX 5 mg/kg to 10 mg/kg or shortened infusion interval). The final observation time was week 52 when efficacy outcomes in the two groups were compared.
A total of 74 patients with CD were included in this study, switch group 15 patients and dose escalation group 59 patients. Three of 15 patients had switched to ADA because of IFX infusion reaction. An 11 of 15 patients (73%) in the switch group together with 35 of 59 patients (59%) in the IFX dose escalate group could continue the treatment up to week 52, all in clinical remission. Further, at week 52, C-reactive protein in the switch group was significantly lower than in the IFX dose escalation group, 0.28±0.387 mg/dL vs 1.13±1.640 mg/dL, respectively (P = 0.009).
In CD patients with the loss of response to IFX, switching to ADA before IFX dose escalation appears to be a clinically relevant therapeutic decision. Potentially, this finding should minimize futile use of IFX and reduce morbidity time for many patients.