title: Outcome after a dose "de-intensification" strategy with anti-TNF drugs in patients with Crohn's disease.
abstract: BACKGROUND
  Dose "intensification" is a recommended strategy to recover therapeutic benefit in Crohn's disease (CD) patients who have lost initial response to anti-TNF therapy. Once patients have achieved remission, dose "de-intensification" can be used for cost and safety reasons.
  
  
  OBJECTIVE
  The primary aim of this study was to evaluate the long-term durability of remission after stepping down anti-TNF therapy. The secondary aim was to identify predictive factors associated with loss of response after "de-intensification" and to evaluate the effectiveness of a second "re-intensification" in patients who lost response after the treatment was stepped down.
  
  
  METHODS
  We evaluated CD patients who received at least one standard anti-TNF dosage after achieving remission with "intensified" anti-TNF therapy.
  
  
  RESULTS
  Twenty-four patients were included. The treatment was "intensified" because of partial response in 11 patients, loss of response in 10, and primary lack of response in 3. Eight of the 24 patients had lost response after a median follow-up of only 7 months after "de-intensification" of the anti-TNF therapy. The anti-TNF drug was "intensified" again in all 8 patients. Three patients did not respond to the new "intensification", two had partial response and three achieved remission. On univariate analysis, no predictive factors were identified for loss of response after treatment "de-intensification".
  
  
  CONCLUSIONS
  After only 7 months of follow-up, one-third of the CD patients who received "de-intensification" therapy lost response; of these, two-thirds did not achieve response after subsequent "re-intensification".
authors.affiliation: Gastroenterology Department, La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain. Electronic address: mariachs2005@gmail.com.
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.affiliation: Gastroenterology Department, Clínico de Santiago, Santiago de Compostela, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.affiliation: Gastroenterology Department, Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Planella
authors.affiliation: Gastroenterology Department, Germans Trias i Pujol, Badalona, Spain.
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.affiliation: Gastroenterology Department, Fuenlabrada, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
authors.affiliation: Gastroenterology Department, Parc Taulí, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Gastroenterology Department, La Paz, Madrid, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Martín Arranz
authors.affiliation: Gastroenterology Department, Consorci Sanitari de Terrassa, Terrasa, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Monfort
authors.affiliation: Gastroenterology Department, La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Adalimumab; Crohn's disease; De-intensification; Desintensificación; Enfermedad de Crohn; Factor de necrosis tumoral; Infliximab; Loss of response; Pérdida de respuesta; Tumour necrosis factor