P573 Frequency and effectiveness of empirical anti-TNF dose intensification in inflammatory bowel disease: an on-going systematic review with meta-analysis

• Published in: Journal of Crohn's and colitis 2020-01, Vol.14 (Supplement_1), p.S482-S483
• Main Authors: Guberna Blanco, L, Nyssen, O P, Chaparro, M, Gisbert, J P
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjz203.701

Abstract Background Loss of response to anti-TNF therapies in inflammatory bowel disease occurs in a high proportion of patients. However, the precise incidence of dose intensification (DI) and its effectiveness remain unclear. Our aims were: (1) To evaluate the need of DI of anti-TNF therapy either by increasing the dose or decreasing doses’ interval; (2) To evaluate possible variables influencing its requirement; (3) To assess the effectiveness of empirical DI. Methods Bibliographical searches were performed until January 2019. Selection: prospective and retrospective studies assessing the loss of response to anti-TNF therapy, considered as the need of DI, in Crohn’s disease (CD) and ulcerative colitis (UC) patients treated for at least 12 weeks with an anti-TNF drug. Exclusion criteria: Studies using anti-TNF as prophylaxis for postoperative recurrence in CD or those where DI was based on therapeutic drug monitoring. Data were analyzed by means of the inverse variance method using a random effect model and stratifying by medical baseline condition (UC vs. CD), anti-TNF drug and follow-up. Effectiveness was assessed by intention-to-treat analysis. Results Up to now, 107 studies (11,377 patients) were included. The overall rate of DI requirement for naïve patients after 12 and 36 months of follow-up was 35% (95% CI=26–45%, I2=95%, 15 studies) and 48% (41–55%, I2= 77%, 9 studies); respectively. Frequencies of DI requirement stratified by subgroup analysis are presented in the table (all patients being naïve except CD patients treated with adalimumab (ADA), including naïve and no naïve). Anti-TNF UC/CD Follow-up time (months) DI requirement (%, 95% CI) I 2 (%) Number of studies included Infliximab (IFX) UC+CD 12 37 (26–48) 95 13 IFX UC+CD 36 48 (41–55) 79 8 IFX UC 12 57 (48–65) 73 5 IFX UC 36 52 (33–71) 87 3 IFX CD 12 25 (16–44) 89 8 IFX CD 36 46 (38–55) 78 5 ADA UC+CD 12 31 (24–38) 91 11 ADA UC+CD 36 43 (36–49) 44 4 ADA UC 12 25 (18–33) 69 2 ADA UC 36 50 (34–66) Not applicable 1 ADA CD 12 33 (24–42) 93 9 ADA CD 36 41 (35–48) 46 3 The overall short-term response and remission rates to empirical DI were 67% (95% CI: 63–72%; I2=73%; 31 studies) and 45% (95% CI: 35–55%; I2=9%; 23 studies), respectively; subgroup analyses are summarised in the table. Anti-TNF UC/CD Remission rate (%, 95% CI) I 2 (%) Number of studies included IFX UC+CD 44 (29–59) 89 10 IFX UC 51 (27–75) 93 5 IFX CD 36 (27–44) 82 5 ADA UC+CD 38 (22–54) 89 8 ADA UC 14 (3–24) 57 3 ADA CD 55(33–77)