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

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.