Dose escalation of biologics in Crohn’s disease: critical review of observational studies

AbstractBackground: Biologics used to treat Crohn’s disease (CD) may lose their effect over time, requiring dose escalation. Little information is available on this topic.Aim: To summarize rates of dose escalation, duration, de-escalation in observational studies of CD in adults treated with adalimumab, infliximab, and vedolizumab in Europe.Methods: Two independent investigators searched Medline and Embase for observational studies published in 1998–2015 and proceedings from four major scientific meetings. Rates were summarized descriptively.Results: In total, 58 articles from 12 European countries were analyzed (49 full articles, nine abstracts), providing 65 reports with 7,850 patients; 35 reported on 3,830 patients with adalimumab (ADA), and 30 on 4,020 patients with infliximab (IFX). Overall, 29.9% ± 3.5% of patients required dose escalation; 32.8% ± 6.2% with ADA and 25.2% ± 2.4% with IFX (p = .35 between drugs). Rates increased according to line of treatment: 19% for first line, 37% second, and 41% ...