How effective is dose escalation of biologicals in IBD?

Dose escalation of biologic therapies appeared to be an effective strategy to recapture clinical response and clinical remission in patients with inflammatory bowel disease (IBD), results of the RAINBOW-IBD study of the ENEIDA registry showed.

“Biologic agents have proven effective in patients with IBD, but many patients require dose escalation after some time, mostly due to a loss of response,” said Dr Cristina Rubín de Célix (University Hospital La Princesa, Spain). The current retrospective, multicentre, non-interventional study aimed to evaluate the frequency and effectiveness of dose escalations of the anti-TNF agents infliximab, adalimumab, and golimumab, the α4β7 integrin inhibitor vedolizumab, and the IL-12/23 blocker ustekinumab.

Of the 19,720 patients with IBD treated with biologic agents, 5,096 (26%) needed dose escalations. “At 1 year, approximately 15% of the patients on anti-TNF agents received a dose escalation; 25–31% of the patients needed a dose escalation at 5 years,” expressed Dr Rubín de Célix. The corresponding rates for vedolizumab were 19% and 33%, and 17% and 37% for ustekinumab.

Clinical remission was achieved in 32–49% of patients receiving dose escalations, depending on the administered agent (see Figure). Recapture of clinical response was high, at 85–92%, across all treatment groups. In patients who regained response following dose escalation, 82–93% were still on treatment at 1 year and 66–88% of patients were still on the dose-escalated treatment at 2 years. Lastly, prior biologic experience, IBD type, and a short evolution of IBD were noted as predictive factors of treatment discontinuation after dose escalation.

Figure: Effectiveness of dose escalation of biologic therapies in IBD [1]



“Thus, dose escalation of biologic therapies is an effective strategy to recapture clinical response and remission in patients with IBD,” concluded Dr Rubín de Célix.

1. Rubín de Célix C, et al. Frequency and effectiveness of dose escalation of biologic therapy in inflammatory bowel disease: the RAINBOW-IBD study of ENEIDA. DOP75, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.

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Posted on 18 April 202418 April 2024