Edward Loftus Jr., M. D., discusses a recent article published in the American Journal of Gastroenterology looking at patients on the standard dose of adalimumab, also known as Humira, who were not doing well. The study focused on dose optimization and predicting remission in patients.
This French study looked at patients with either Crohn's disease or ulcerative colitis on the standard dose of adalimumab that were not doing well. In the group of roughly 100 patients, the researchers checked levels of adalimumab and antibodies to adalimumab in the patients right before delivering the next dose. Based on the profile from the tests, the researchers put the patients into three groups: patients that had therapeutic levels of adalimumab, patients that had low levels of adalimumab but no antibodies to the drug, and patients that had low levels of adalimumab and antibodies to the drug.
All the patients underwent dose optimization. If a patient wasn't doing well by receiving doses every other week, the dose was escalated to 40 mg weekly. If patients still weren't do well receiving a dose increase, they were switched to a different anti-TNF drug.
Based on the three profiles, the researchers could predict how patients were going to react. The patients who had low levels of adalimumab but no antibodies did best when the dose was doubled from every other week to weekly. The patients that had antibodies to adalimumab and already had therapeutic levels of adalimumab didn't do well with dose optimization. The patients that did the best when switching to a different anti-TNF drug were patients that had low levels of adalimumab and already had antibodies.
Based on this study, physicians can predict how patients might respond to certain therapies. This will help physicians make rational, evidence-based decisions on how to manage patients.
Read the full study online here.
For more information on IBD, visit mayoclinic.org/ibd.
Dr. Loftus is a gastroenterologist at Mayo Clinic.