title: Adalimumab dose escalation is effective and well tolerated in Crohn's disease patients with secondary loss of response to adalimumab.
abstract: BACKGROUND
  Although adalimumab is effective in Crohn's disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn's disease patients with a secondary loss of response.
  
  
  METHODS
  We performed a retrospective and observational study including all Crohn's disease patients who underwent dose escalation of adalimumab after a secondary loss of response from 2007 to 2015.
  
  
  RESULTS
  A clinical response was observed in 99/124 (79%) patients at 3 months and in 62/107 (61%) patients at 12 months. The predictive factors of response to ADA dose escalation at 12 months on multivariate analysis were: maintenance therapy of 40mg every week rather than 80mg every other week (OR 3.64, 95% CI: 1.28-10.37) and a CRP level≤5mg/L at adalimumab dose escalation (OR 6.64, 95% CI: 1.40-27.53). Adalimumab was withdrawn in 4 patients due to side effects.
  
  
  CONCLUSIONS
  Adalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss of response. A 40mg every week optimized regimen was predictive of a response to ADA dose escalation.
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Duveau
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Nachury
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Gerard
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Branche
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Maunoury
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Medina
authors.initials: M
authors.lastname: Boualit
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Wils
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Desreumaux
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France. Electronic address: benjamin.pariente@chru-lille.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pariente
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003424:Crohn Disease / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D060046:Maintenance Chemotherapy; D008297:Male; D015999:Multivariate Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000068879:Adalimumab
keywords: Anti-TNF; Optimization; Therapeutic strategy