Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/100935
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Type: Journal article
Title: Dose tailoring of anti-tumour necrosis factor-alpha therapy delivers useful clinical efficacy in Crohn disease patients experiencing loss of response
Author: Ghaly, S.
Costello, S.
Beswick, L.
Pudipeddi, A.
Agarwal, A.
Sechi, A.
Antoniades, S.
Headon, B.
Connor, S.
Lawrance, I.
Sparrow, M.
Walsh, A.
Andrews, J.
Citation: Internal Medicine Journal, 2015; 45(2):170-177
Publisher: Wiley
Issue Date: 2015
ISSN: 1444-0903
1445-5994
Statement of
Responsibility: 
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, and J. M. Andrews, on behalf of AIBDA
Abstract: Background: ‘Dose tailoring' of anti-tumour necrosis factor alpha (TNF-α) therapy in Crohn disease (CD), by dose escalation, or shortening of dosing intervals, has been suggested to regain clinical response following a flare in a proportion of patients. However, reported outcome data are sparse and none exists from Australia.Method: In an observational multicentre, retrospective study, the impact of anti-TNF-α dose tailoring on corticosteroid use, the need for surgery and physician perception of clinical efficacy was examined in a real-world setting at six Australian adult teaching hospitals. Demographics, disease characteristics, medications, indication for and duration of dose tailoring were documented. Results: Fifty-five CD patients were identified as requiring dose tailoring and secondary loss of response was the indication in 96%. Either adalimumab (64%) or infliximab (36%) was dose escalated for a median of 5 months (range 1-47), with a median of 20 months follow up (range 3-65). At 3 months, dose tailoring reduced the mean number of days on high-dose corticosteroids (45 vs 23, P = 0.01). Most (78%) patients remained resection free, and 73% of physicians reported good clinical efficacy of dose tailoring. Of those who de-escalated therapy due to induction of remission, long-term (>12 months) follow up and complete data on steroid use were available in 15/28, with 12/15 (80%) remaining steroid free at 1 year.Conclusion: Short-term dose tailoring regains disease response in the majority of patients with CD. Of these, most will remain free of corticosteroids at 1 year after de-escalating therapy.
Keywords: Crohn disease; Infliximab; Adalimumab; Anti-TNF-α, Dose escalation
Rights: © 2014 Royal Australasian College of Physicians
DOI: 10.1111/imj.12621
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