P645 Adalimumab drug monitoring is superior to empirical treatment adjustment in inflammatory bowel disease

• Published in: Journal of Crohn's and colitis Vol. 14; no. Supplement_1; pp. S533 - S534
• Main Authors: CURRAIS, P, Fernandes, S, Bernardo, S, Correia, L, Gonçalves, A R, Baldaia, C, Moura Santos, P, Valente, A, Tato Marinho, R
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15-01-2020
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjz203.773

Abstract
Background
Anti-TNF blockers are effective drugs in the treatment of inflammatory bowel disease (IBD). Therapeutic drug monitoring (TDM) of Adalimumab (ADA) may potentially improve clinical outcomes in this setting, but data are still scarce.
Methods
To compare ADA TDM and empirical treatment adjustment (ETA) in patients with IBD. Outcomes were evaluated at 2 years and included hospitalisation, surgery, treatment discontinuation, endoscopic remission and treatment failure (any unfavourable event).
Single-centre retrospective study, including patients under ADA therapy.
Results
103 patients were included, 86 with Crohn’s disease and 17 with ulcerative colitis. 52.4% male, mean age 28.5 (18–72). 56 patients received ADA TDM and 47 ETA. At 2-years, rates of treatment escalation (57.1% vs. 21.3%, p <0.001), mucosal healing (69.6% vs. 48.9%, p =0.032) and treatment discontinuation (17.9% vs. 4.3%, p =0.032) favored the TDM group. For TDM and ETA respectively, there was no statistically significant difference regarding need for hospitalisation (12.5% vs. 21.3%, p = 0.232), surgery (5.4% vs. 14.9%, p =0.103) and treatment failure (26.7% vs. 34.5%, p =0.395).
Conclusion
Our results suggest a benefit of TDM in achieving higher rates of mucosal healing The higher rates of treatment discontinuation suggest that TDM improves drug selection as patients switched unhelpful treatment earlier.