Predicting Remission After Adalimumab Dose Optimization

Edward Loftus Jr., M. D., a gastroenterologist at Mayo Clinic, discusses a recent article published in the American Journal of Gastroenterology looking at patients on the standard dose of adalimumab who were not doing well. The study focused on dose optimization and predicting remission in patients.

Hi my name is ed loftis i’m a gastroenterologist who specializes in inflammatory bowel disease and i wanted to talk to you today about an article that appeared in the american journal of gastroenterology this was from a french group and they were looking at patients with either crohn’s disease or ulcerative colitis who were on a drug called adeline ab also known as

Humera and they were looking at specifically the patients who were on the standard dose of 40 milligrams subcutaneous every other week and who were not doing well and they went ahead in this group of roughly 100 patients they checked levels of the adilimum so levels of the actual drug right before they’re supposed to get the next dose and also antibodies to add a

Lymphemat and based on that profile they could group the patients into three groups either patients that had therapeutic levels of adolem patients who had low levels of adolem but no antibodies to the drug and patients who had low levels of adolement who did have antibodies to the drug all the patients underwent what they call dose optimization so if they weren’t

Doing well on every other week their dose was escalated to 40 milligrams subcutaneously weekly if they still didn’t do well on that dose ultimately they were put on a different anti-tnf drug called infliximab also known as remicade and based on those original three profiles i was talking about they could sort of predict how patients weren’t gonna were gonna do

And what happened was amongst the patients who had the low drug level but no antibodies to the drug those patients did best during the phase where the dose of the adelimimab was doubled when it went from every other week to weekly and that kind of makes sense whereas the patients who already had antibodies to the drug they didn’t do well with dose optimization and

The patients who already had a therapeutic level of the drug and weren’t doing well they didn’t do so hot either and then in the second part of the study when they went on infliximab the patients who did the best were the patients who had the low drug levels but already had antibodies to the adolemia map when they went on inflixamat they did much better the group

That seemed to do the worst overall was that first group i talked about who had therapeutic levels of ad limit so despite having therapeutic levels of an anti-tnf drug these patients were symptomatic and it didn’t matter whether you increased the dose of the adelimimab or gave them infliximab 90 of them did not do well and so based on this pharmacokinetic profile

If you will you could group people into three groups and sort of predict how to treat them so in my own practice if i have a patient not doing well in adolemimab i check a trough level in antibodies if they have a low level of drug no antibodies i increase the dose of adelimimab if they have a low level drug but they have antibodies we switch them to a different

Anti-tnf drug if they already have a therapeutic dose of adelimimab and yet they’re not doing well then you probably need to switch out of class to a different drug with a different mechanism of action and that might be an anti-integrin antibody or something along those lines and so this is the future of ibd we’re going to see this more and more with all of our

Biologic drugs the ability to check trough levels antibodies to the drug and then make rational evidence-based decisions on how to manage these patients this concept is very similar to a paper that we did here at mayo several years ago where we profiled people based on their infliximab levels and you could predict how well they would do with different strategies thank you very much

Transcribed from video
Predicting Remission After Adalimumab Dose Optimization – IBD in the News By Mayo Clinic