IBD

54 - Anti-TNF Dose Augmentation Frequently Occurs in the Absence of Objective Evidence of Disease Activity

Tuesday, October 9
3:35 PM - 3:45 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: IBD
Evan Elias, MD, Adebanke Oketola, BSc, MSc, Harminder Singh, MD, MPH, Charles Bernstein, MD, Laura Targownik, MD, MSHS
University of Manitoba, Winnipeg, MB, Canada

Award: Fellows-in-Training Award (IBD Category)

Introduction: Anti-TNF dose is frequently increased or dosing interval shortened in IBD subjects with persistent gastrointestinal symptoms. Evidence supporting dose augmentation is of low quality and the practice imparts a significant additional cost of care. Persons with symptoms ascribed to IBD may not have evidence of ongoing inflammation and therefore would not be expected to benefit from dose augmentation. We sought to determine the extent to which clinicians routinely assessed the presence of active inflammation prior to undertaking anti-TNF dose augmentation.

Methods: Medical records of all IBD patients prescribed anti-TNF therapy from 2007-2016 by 8 of 23 Manitoba gastroenterologists were reviewed and demographics, disease characteristics, and IBD treatments recorded. Patients who underwent anti-TNF dose augmentation were further reviewed for the presence of objective assessment of inflammation - including laboratory investigations (CRP, ESR, albumin, ferritin, hemoglobin, fecal calprotectin), cross-sectional abdominal imaging, and endoscopy - in the 90 days preceding dose augmentation.

Results: 529 subjects receiving anti-TNF therapy were identified, of whom 151 had anti-TNF doses augmented on 195 occasions (117 CD, 34 UC). 51 subjects (43.6%) with CD had penetrating disease while 16 (47.1%) with UC had pancolitis. Mean age at diagnosis was 25.5 years and 50.3% of subjects were female. There was no difference in demographics, disease phenotype, or baseline lab values between those who received dose augmentation and those who did not.

Biochemical evidence of inflammation was assessed prior to dose augmentation on 134 of 195 occasions (68.7%). Results of these investigations were abnormal in only 23 cases (11.8%). Cross-sectional imaging was performed in 11 cases (5.6%) and revealed active disease in 8 (4.1%). Endoscopy was performed on 28 occasions (14.4%) with 24 (12.3%) revealing active disease. Overall, objective evidence of inflammation was present for 48 of 195 dose augmentation events (24.6%), no evidence of inflammation was present for 95 (48.7%), and no investigations were performed for 52 (26.7%).

Discussion: Anti-TNF dose augmentation routinely occurs in the absence of objective evidence of active inflammatory disease. This represents a target for ongoing quality improvement to optimize care of persons with IBD requiring anti-TNF based therapies given the significant economic burden of unjustified and potentially unnecessary dose augmentation.


Disclosures:
Evan Elias indicated no relevant financial relationships.
Adebanke Oketola indicated no relevant financial relationships.
Harminder Singh indicated no relevant financial relationships.
Charles Bernstein: 4D Pharma – Consultant. Abbvie Canada – Advisory Committee/Board Member, Grant/Research Support. Ferring Canada – Advisory Committee/Board Member, Speaker's Bureau. Janssen Canada – Advisory Committee/Board Member, Grant/Research Support. Mylan Pharmaceuticals – Consultant. Pfizer Canada – Advisory Committee/Board Member, Grant/Research Support. Shire Canada – Advisory Committee/Board Member, Grant/Research Support, Speaker's Bureau. Takeda Canada – Advisory Committee/Board Member, Grant/Research Support.
Laura Targownik: Abbvie canada – Advisory Committee/Board Member. Ferring – Advisory Committee/Board Member. Jansson canada – Advisory Committee/Board Member, Grant/Research Support. Merck – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Takeda canada – Advisory Committee/Board Member.

Evan Elias

University of Manitoba
Winnipeg, Manitoba, Canada

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