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.

Objectives: 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".

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.