Anti-TNF dose augmentation occurs without evidence of active IBD

PHILADELPHIA — Patients with inflammatory bowel disease on anti-TNF therapy often have their dose augmented without any evidence of active inflammation, according to research presented at the American College of Gastroenterology Annual Meeting.

Evan Elias, MD, of the University of Manitoba in Winnipeg, Canada, said that while augmentation is necessary in some cases, data to support its use is somewhat lacking.

“When we look at long-term anti-TNF therapies in IBD patients, we know that up to 40% of initial anti-TNF responders will subsequently develop secondary loss of response with time,” Elias said in his presentation. “The evidence to support augmented-dose TNF is significantly weaker than what we have for standard doses, where there are a number of randomized controlled trials.”

To determine the extent to which physicians regularly assess the presence of active inflammation before they augment a patient’s anti-TNF dosing, Elias and colleagues analyzed medical records of all patients with IBD who were prescribed anti-TNF therapy between 2007 and 2016 by eight Manitoba gastroenterologists (n = 529). They assessed demographics, disease characteristics and IBD treatment for each patient.

Researchers determined that 151 patients had their anti-TNF doses augmented on 195 occasions (Crohn’s disease, n = 117; ulcerative colitis, n = 34). Among patients with CD, 51 had penetrating disease (43.6%) and 16 patients with UC had pancolitis (47.1%).

Of the 134 occasions when inflammation was assessed before augmentation, researchers found that the results were abnormal in just 23 (11.8%). Objective evidence of inflammation was present for 48 events (24.6%), no evidence of inflammation was present for 95 events (48.7%), and no investigations were performed for 52 events (26.7%).

Elias said they believe there is room for ongoing quality improvement when it comes to investigating patients prior to augmenting anti-TNF dosing.

“We’ve shown that anti-TNF dosing is routinely increased without objective evidence of active inflammation,” Elias said. “That’s particularly notable given both the cost of biologic therapies, as well as the fact that once patients are on augmented doses they tend to persist with those augmented doses over quite a long period of time.” – by Alex Young

Reference :

Elias E, et al. Abstract 54. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Elias reports no relevant financial disclosures. Please see the study abstract for all other authors’ relevant financial disclosures.