P0766 Rate and predictors of successful anti-TNF de-escalation in dose escalated IBD patients. A real-world Greek - Turkish collaborative study
Authors: Viazis N , Toruner M , Papastergiou V , Mousourakis K , Christidou A , Tzouvala M , Zacharopoulou E , Theocharis G , Geramoutsos G , Theodoropoulou A , Velegraki M , Çelik A F , Akpinar A , Zampeli E , Papathanasiou E , Unal N G , Kapsoritakis A , Argyriou K , Christodoulou D , Fousekis F , Karakan T , Koutroubakis I , Drygiannakis I , Giouleme O , Kalogirou M , Liatsos C , Kyriakos N , Tsironi E , Markopoulos P , Bamias G , Chalakatevaki K , Tsiolakidou G , Tribonias G , Kasapidis P , Paraskeva K , Telli P , Akyuz F ,   Kostas Karmiris Kostas Katsanos Maria Palatianou Evangelina Vlachou Charikleia Lamouri Konstantina Dimopoulou
Published: January 2025

Abstract

Background
Anti-TNFa agents (anti-TNFs) are still the first line therapy for patients with Inflammatory Bowel Disease (IBD). We aimed to i) report IBD patients receiving anti-TNFs, who needed dose escalation because of secondary loss of response, and (ii) identify the rate and predictors of successful dose de-escalation.

Methods
Multicenter retrospective cohort study. Data were collected from consecutive patients with IBD followed up in referral centers in Greece and Turkey, who initially responded to the standard treatment scheme with anti-TNFs and subsequently received intensified regimens, because of secondary loss of response. Clinical response, steroid free clinical remission, biochemical response and/or mucosal healing were evaluated at 3 and 6 months after dose escalation. Adverse events were also recorded. Predictors for successful dose de-escalation were sought using multivariate analysis.

Results
A total of 1129 patients (Crohn’s disease = 743, ulcerative colitis = 386) were included in the analysis. Of those, 650 patients were receiving Infliximab (57.6%), 471 Adalimumab (41.7%) and 8 Golimumab (0.7%). The median (IQR) duration of treatment with anti-TNF before the need for dose escalation was 13.0 (6.0-36.0) months; precisely 12.0 (6.0-34.0), 14.0 (6.0-37.5) and 4.0 (1.7-5.0) months for Infliximab, Adalimumab and Golimumab, respectively. After a median (IQR) period of 16.0 (8.0-36.0) months, 283 (25.1%) patients were successfully de-escalated to the standard anti-TNF regimen, while 506 (44.8%) patients were switched to an agent with a different mode of action and 340 (30.1%) patients remained in the escalated anti-TNF dosage. The cumulative incidence rates of successful treatment de-escalation at 12, 36, 60 and 96 months were 8.4%, 30.1%, 48.5% and 57.9% respectively. No serious adverse events necessitating anti-TNF discontinuation were noted during the period of intensified treatment. Predictors of successful dose de-escalation were the concomitant use of steroids at the time of dose escalation and the anti-TNFa agent used (infliximab vs adalimumab or golimumab), whereas the presence of extra-intestinal manifestations, prior anti-TNF exposure (adalimumab use before the administration of infliximab and vice versa) and longer duration of anti-TNF administration before dose escalation influenced negatively the attempt of dose de-escalation.

Conclusion
In this multi-center cohort study, one fourth of patients with IBD necessitating intensified treatment with anti-TNFs, because of secondary loss of response, were successfully de-escalated to the standard anti-TNF dose, after a median (IQR) period of 16.0 (8.0-36.0) months.