Area Editoriale
Questo il dato più rilevante della analisi della casistica di Rotterdam, in cui il rischio di passaggio alla somministrazione settimanale è risultato del 46 per cento nei pazienti mai trattati con infliximab, del 15 per cento nei pazienti che avevano precedentemente risposto all'infliximab ma ben del 57 per cento nei pazienti con precedente perdita di risposta all'infliximab. Unica altra associazione rilevata quella con un elevato BMI. Da notare che tutti i pazienti erano stati trattati con il dosaggio di induzione 160/80.
NB per ulteriori dati sulla perdita di risposta e necessità di inensificazione della terapia con adalimumab si rimanda alle recenti analisi delle casistiche di Chicago e della Mayo Clinic citati in questa area tematica e alla revisione sistematica degli studi precedenti pubblicata in aprile 2011 (vedi riferimento su PubMed)
Predictors of dose escalation of adalimumab in a prospective cohort of Crohn's disease patients.Bultman E, de Haar C, van Liere-Baron A, Verhoog H, West RL, Kuipers EJ, Zelinkova Z, Janneke van der Woude C. Aliment Pharmacol Ther. 2012;35:335-41.
Background Adalimumab is effective for the induction and maintenance of remission in Crohn's disease (CD)-patients. Aim To find predictors for adalimumab dose escalation at initiation of adalimumab. Methods Crohn's disease patients in a single tertiary referral centre who started adalimumab between July 2007 and March 2010 at an induction dose (week 0 160 mg subcutaneously (sc), week 2 80 mg sc) and maintenance dose of 40 mg sc thereafter every other week were followed prospectively. Patients on adalimumab for at least 3 months were ncluded. The number of patients needing dose escalation was assessed. Patients that needed dose escalation were compared with patients that did not need dose escalation. Results Of 199 CD patients treated with adalimumab and followed prospectively, 122 patients (M/F 54/68, median age 35 years, range 18-66 years, median CDAI 164, range 6-468) were treated for 3 months. In total 38% of these patients (46/122) needed a dose escalation within a median time of 21 weeks after adalimumab introduction (range 4-105). Body mass index (BMI) (P < 0.03) and secondary non-response to infliximab (IFX) (P < 0.06) were identified as
predictors for dose escalation. Concomitant use of immunomodulators at initiation of adalimumab and the presence of autoantibodies to IFX did not predict dose escalation. Conclusions Over one-third adalimumab-treated patients are dose escalated within a median of 5 months. Higher BMI and secondary non-response to IFX treatment are predictive for a dose escalation during adalimumab treatment.