Rate and predictors of successful antitumor necrosis factor deescalation after dose intensification in inflammatory bowel disease patients: a real-world Greek–Turkish collaborative study

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OBJECTIVES: To identify the rate and predictors of successful antitumor necrosis factor (TNF) dose deescalation in patients with inflammatory bowel disease (IBD). METHODS: This multicenter retrospective cohort study collected data from consecutive IBD patients followed at referral centers in Greece and Turkey, who had received intensified anti-TNF regimens due to secondary loss of response. Clinical response, steroid-free clinical remission, biochemical response, or mucosal healing were evaluated at 3 and 6 months following dose escalation. Multivariate analysis was used to identify predictors of successful dose deescalation. RESULTS: A total of 1129 patients were included [Crohn's disease: n = 743; ulcerative colitis: n = 386; infliximab (IFX): n = 650; adalimumab (ADA): n = 471; and golimumab (GOL): n = 8]. The median interquartile range (IQR) duration of anti-TNF treatment before escalation was 13.0 (6.0-36.0) months. After a median (IQR) of 16.0 (8.0-36.0) months of intensified therapy, 283 (25.1%) patients were successfully deescalated to standard anti-TNF dosing, 340 (30.1%) remained on the intensified regimen, and 506 (44.8%) were switched to a different agent - either another anti-TNF ( n = 111, 21.9%) or a biologic with a different mechanism of action ( n = 395, 78.1%). Predictors of successful deescalation included the concomitant use of steroids and the type of anti-TNFa agent used (IFX vs. ADA/GOL). Negative predictors included the presence of extraintestinal manifestations, prior anti-TNF exposure (i.e. ADA followed by IFX and vice versa), and longer duration of anti-TNF therapy before escalation. CONCLUSION: One quarter of IBD patients requiring intensified anti-TNFa therapie were successfully deescalated to standard dosing, after a median of 16.0 (IQR: 8.0-36.0) months.

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