Dose tailoring of anti‐tumour necrosis factor‐alpha therapy delivers useful clinical efficacy in Crohn disease patients experiencing loss of response

• DOI: 10.1111/imj.12621
• Publication Date: 2014-11-05T10:46:34Z
• Authors: S. Ghaly; S. Costello; L. Beswick; A. Pudipeddi; A. Agarwal; A. Sechi; S. Antoniades; B. Headon; S. Connor; I. C. Lawrance; M. Sparrow; A. J. Walsh; J. M. Andrews
• Keywords: Demographics

'Dose tailoring' of anti-tumour necrosis factor alpha (TNF-α) therapy in Crohn disease (CD), by dose escalation, or shortening dosing intervals, has been suggested to regain clinical response following a flare proportion patients. However, reported outcome data are sparse and none exists from Australia.In an observational multicentre, retrospective study, the impact anti-TNF-α tailoring on corticosteroid use, need for surgery physician perception efficacy was examined real-world setting at six Australian adult teaching hospitals. Demographics, characteristics, medications, indication duration were documented.Fifty-five CD patients identified as requiring secondary loss 96%. Either adalimumab (64%) infliximab (36%) escalated median 5 months (range 1-47), with 20 follow up 3-65). At 3 months, reduced mean number days high-dose corticosteroids (45 vs 23, P = 0.01). Most (78%) remained resection free, 73% physicians good tailoring. Of those who de-escalated due induction remission, long-term (>12 months) complete steroid use available 15/28, 12/15 (80%) remaining free 1 year.Short-term regains majority CD. these, most will remain year after de-escalating therapy.