DOP51 De-escalation of biological therapy in Inflammatory Bowel Disease patients following prior escalation
Thomas, P.(1);Smits, L.(1);Te Groen, M.(1);West, R.(2);Russel, M.(3);Jansen, J.(4);Römkens, T.(5);Hoentjen, F.(1)
(1)Radboudumc, Gastroenterology and Hepatology, Nijmegen, The Netherlands;(2)Franciscus Gasthuis & Vlietland, Gastroenterology and Hepatology, Rotterdam, The Netherlands;(3)Medisch Spectrum Twente, Gastroenterology and Hepatology, Enschede, The Netherlands;(4)Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, The Netherlands;(5)Jeroen Bosch Ziekenhuis, Gastroenterology and Hepatology, 's-Hertogenbosch, The Netherlands
Background
There are limited data available on de-escalation of biological therapy after prior escalation in inflammatory bowel disease (IBD) patients. The aim of this study was to assess the frequency and success rate of de-escalation of biological therapy in IBD patients after prior dose escalation and evaluate which measures are used prior to de-escalation.
Methods
This multicentre, prospective, cohort study enrolled IBD patients treated with infliximab (IFX), adalimumab (ADA) or vedolizumab (VEDO) in whom therapy was de-escalated at least once after prior biological escalation. Objective disease measures for de-escalation were defined as faecal calprotectin ≤ 200 µg/g and/or therapeutic or supratherapeutic trough levels and/or radiologic or endoscopic remission. Successful de-escalation was defined as remaining on the same or lower biological dose for ≥6 months after de-escalation.
Results
In total, 206 IFX users, 85 ADA users and 55 VEDO users underwent therapy escalation. Of these, 34 (17%) patients on IFX, 18 (21%) patients on ADA and 8 (15%) patients on VEDO had received at least one subsequent de-escalation. De-escalation was successful in 91% of IFX patients, 89% of ADA patients and 100% of VEDO patients. The probability of remaining on the de-escalated regimen or further de-escalation after 1 year was 85% for IFX, 62% for ADA and 100% for VEDO. De-escalation based on objective disease measures was performed in 67% of all de-escalations. Objective de-escalations were successful in 98% versus 80% of subjective de-escalations.
Conclusion
De-escalation after biological escalation is successful in the majority of patients. Objective markers of remission increase the likelihood of successful de-escalation.