P0948 Comparative outcomes of Adalimumab and Infliximab dose escalation in Inflammatory Bowel Disease patients failing first-line biologic treatment

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Abstract Background Dose escalation has been commonly used as a strategy to achieve and maintain response; however, there was no research studied in patients who dose escalated with ulcerative colitis (UC) and Crohn’s disease (CD) who failed first-line anti-TNF-α therapy. We aimed to compare the outcomes of adalimumab (ADA) or infliximab (IFX) dose escalation in inflammatory bowel disease (IBD) patients. Methods All patients were evaluated between 2019 and 2024. Treatment persistence (TP) and the predictor factors for discontinuation were evaluated in patients treated with ADA or IFX dose escalation. Results A total of 749 patients received either ADA 409 (54.6%) or IFX 340 (45.4%) as their first-line biologic agent. Among them, dose escalation was identified in 142 (34.7%) patients of ADA group (UC: 34, 23.9% and CD: 108, 76.1%) and in 126 (37.0%) patients of IFX group (UC: 30, 23.8% and CD: 96, 76.2%). Concomitant immunomodulator use was lower in ADA group; however, erythema nodosum, budesonide use, and BMI were higher in ADA group. Other baseline characteristics were similar between the groups. The treatment persistence rate was significantly lower in ADA group (50, 35.2%) than IFX group (67, 53.2%) (p=0.003). The survival analysis showed that drug durability was lower in ADA group than IFX group (mean time: 74.3 vs 99.5 months, p<0.001, respectively). TP rates were no significantly differences between UC and CD in both ADA (mean time UC: 64.7 months vs CD: 76.2 months, p=0.403) and IFX (Mean time UC: 80.3 months and CD: 102.6 months, p=0.151). Remission-free treatment discontinuation rates were significantly higher in the ADA group (89, 62.7%) than IFX group (50, 39.7%) (p<0.001). Both primary lack of response and secondary loss of response (sLOR) rates were higher in ADA group (11, 7.7% and 73, 51.4%, respectively) than IFX group (2, 1.6% and 36, 28.6%, respectively). In the subgroup analysis of the sLOR, steroid needed was significantly higher in ADA group (15, 10.6%) than IFX group (4, 3.2%) (p=0.019) and switch to another biotherapy was higher in ADA group (72, 50.7%) than IFX group (35, 27.8%) (p<0.001). However, serious adverse events were lower in ADA group (3, 2.1 %) than IFX group (10, 7.9%) (p=0.027). Conclusion IFX dose escalation was more effective than ADA dose escalation in both UC and CD patients. Regarding the side effect profile, ADA dose escalation was found to be safer compared to IFX.