Supported in part by the American Gastroenterological Association Foundation Student Research Fellowship Award and the Digestive Disease Research Core Center of the University of Chicago (DK42086).
Predictors of adalimumab dose escalation in patients with crohn's disease at a tertiary referral center†
Article first published online: 31 MAR 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 1, pages 10–16, January 2012
How to Cite
Cohen, R. D., Lewis, J. R., Turner, H., Harrell, L. E., Hanauer, S. B. and Rubin, D. T. (2012), Predictors of adalimumab dose escalation in patients with crohn's disease at a tertiary referral center. Inflamm Bowel Dis, 18: 10–16. doi: 10.1002/ibd.21707
- Issue published online: 11 DEC 2011
- Article first published online: 31 MAR 2011
- Manuscript Accepted: 15 FEB 2011
- Manuscript Received: 10 JAN 2011
- Crohn's disease;
- inflammatory bowel disease;
- anti-TNFα therapy;
Pivotal trials for adalimumab (ADA) demonstrated effectiveness versus placebo for induction and maintenance of remission in moderate to severely active Crohn's disease (CD). Although the approved maintenance regimen in the U.S. is 40 mg subcutaneously every 14 days, some patients require dose-escalation ([DE] either an increase in the delivered dose or decrease in the interval of treatment). Our objective was to determine which patient-, disease-, and therapy-related factors were associated with DE in CD patients treated with ADA.
This retrospective medical record review of patients included all patients treated with ADA for CD at the University of Chicago Inflammatory Bowel Disease Center between 2003 and 2008. Patient-related factors, disease-related factors, and therapy-related factors were analyzed. Survival and logistic regression analyses were performed.
In all, 75 patients treated with ADA between December 2003 and June 2008 were identified. Thirty-one subjects (41%) required DE (32% male, median age 37.6, median disease duration 22.7 years) after a median 20 weeks of therapy (range 2–75). Patient-, clinical-, and therapy-related factors were similar between DE and non-DE. Need for DE was predicted by a family history of inflammatory bowel disease (IBD) (P = 0.0187). Time to DE was predicted by male gender, isolated colonic disease, and smoking history (all P < 0.05); however, only male gender was an independent predictor of time to DE.
In all, 41% of CD patients required ADA DE, with shorter time to DE in smokers, men, and patients with isolated colonic disease. Patients, caregivers, and insurers should anticipate DE when utilizing ADA in CD. (Inflamm Bowel Dis 2011;)