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* = Presenting author

P408 Differences in biologic efficacy and dose-escalation among anti-TNF agents in Crohn´s disease and ulcerative colitis

A. Echarri*1, P. López-Casado2, R. Fraga1, V. Ollero1, L. García-Dieguez1

1Complejo Hospitalario Ferrol, Gastroenterology, Ferrol, Spain, 2Universidad de Valladolid, Estadística, Valladolid, Spain

Background

Secondary loss of response is a frequent event occurring during anti-TNF therapy that usually requires dose intensification. The aim of this study was to evaluate differences in the prevalence of dose-escalation among Crohn´s disease (CD) and ulcerative colitis (UC) patients treated with infliximab (IFX) or adalimumab (ADA) in clinical practice.

Methods

We performed a retrospective observational study of patients with IBD receiving IFX/ADA treatment from January 2011 until April 2014 at our Unit. Patients losing response after 2 months or more of anti-TNF maintenance therapy and in whom treatment was intensified were included. Differences in the rates of dose intensification and intensification time, between CD patients on IFX/ADA treatment were compared. We also evaluated differences in the risk for intensification between CD/UC patients on IFX treatment.

Results

Of 83 patients (CD=62, UC=21) receiving anti-TNF treatment (IFX=44, ADA=39), 34 patients (CD=19, UC=15) received dose intensification (IFX=23, ADA=11). Clinical remission was achieved in 76.9% of CD patients treated with ADA and 69.6% of CD patients on IFX treatment. We observed clinical remission in 81% of UC patients treated with IFX. No statistically significant difference was found between any of the groups.

Intensification was observed in 20% and 25% of CD patients treated with ADA and IFX respectively. Loss of response occurred in the first year of IFX/ADA treatment in 88% and 64% of cases respectively. Although the percentage of earlier loss of response was higher in the IFX group, no statistically significant differences were found. The rate of intensification per CD patient-month during the first year of IFX/ADA therapy was 2.8 and 1.5 respectively.

Significantly more UC patients on IFX treatment experienced dose intensification compared with CD patients (72% vs 25%; p=0.0366). The relative risk to experience loss of response to IFX in UC patients was 2.05 (95% CI 1.10-3.82) significativily higher than the risk of intensification in CD patients. The rate of intensification per patient-month during the first year of IFX therapy was 2.8 for CD and 3.9 for UC (p<0.005). De-escalation was higher in UC than CD patients although no significative statistical differences were found.

Conclusion

In our large cohort of IBD patients receiving anti-TNF treatment dose intensification is often required.

In nearly 25% of CD patients on anti-TNF treatment, dose escalation was required especially in the first year of treatment independently of which anti-TNF was being used.

UC patients on IFX treatment showed a higher risk for loss of response compared with CD patients, although deintensification was possible in a higher percentage of UC patients