Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis

Taxonera, Carlos; Acosta, Manuel Barreiro‐de; Calvo, Marta; Saro, Cristina; Bastida, Guillermo; Martín-Arranz, María Dolores; Gisbert, Javier P.; García–Sánchez, Valle; Marín-Jiménez, Ignacio; Bermejo, Fernando; Chaparro, María; Ponferrada, Ángel; Martínez-Montiel, María Pilar; Pajares, Ramón; Gracia, Celia De; Olivares, David; Alba, Cristina; Mendoza, Juan L.; Fernández-Blanco, Ignacio

doi:10.1007/s10620-015-3735-4

Cited by 31 publications

(44 citation statements)

References 32 publications

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“…Although it should be noted that dose-escalation is not within license or NICE guidance, the 50 and 100 mg maintenance doses are priced equally in the UK suggesting that dose escalation is a cost-effective option in patients with a suboptimal response to 50 mg maintenance dosing. Of course, this is not a particularly novel approach in the use of biologics for IBD; evidence-based dose escalation strategies already exist for infliximab,34 adalimumab35 and vedolizumab36 37 and seem likely also to be useful for ustekinumab 38. However, empirical dose escalation can incur undue costs39–41 and perhaps a more rational approach to dose optimisation would be to use therapeutic drug monitoring to quantify serum golimumab concentrations as well as to identifying the presence or absence of antidrug antibodies 42.…”

Section: Discussionmentioning

confidence: 99%

Golimumab: early experience and medium-term outcomes from two UK tertiary IBD centres

Samaan

Pavlidis

Digby-Bell

et al. 2017

Frontline Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Golimumab: early experience and medium-term outcomes from two UK tertiary IBD centres

Samaan

Pavlidis

Digby-Bell

et al. 2017

Frontline Gastroenterol

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“…[24][25][26] Dose escalation in these cases has been shown to be efficacious, resulting in remission/response in patients who lost response to the initial biologic drug. 23,[27][28][29][30][31][32][33][34][35][36] However, these dose modifications may result in unexpected increased drug costs to payers in the United States.…”

Section: ■■ Methods Data Sourcementioning

confidence: 99%

Dose Escalation Assessment Among Targeted Immunomodulators in the Management of Inflammatory Bowel Disease

Ehrenberg

Griffith

Theigs

et al. 2020

JMCP

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BACKGROUND:The need for individualized treatment regimens is becoming more important in the management of patients with inflammatory bowel disease (IBD). Gastroenterologists may dose adjust either by increasing the dose or shortening the dosing interval from the initial recommended maintenance dose to achieve an appropriate clinical response. Understanding the role of dose escalation in the treatment of IBD in clinical practice provides payers in the United States insight into the real-world cost-effectiveness of targeted immunomodulators (TIMs) in the management of IBD. OBJECTIVE: To assess the prevalence and magnitude of dose escalation for approved IBD therapies. METHODS: Using the Source Healthcare Analytics database, patients with IBD who initiated treatment with a drug of interest from July 2015 to June 2017 were identified. Patient utilization of the TIMs was tracked for 12 months following initiation. All included patients had at least 2 diagnoses for ulcerative colitis or Crohn disease before TIM initiation and at least 5 claims for a drug of interest within the 12 months following initiation. Dose escalation was defined as an increase of at least 30% in the average daily dose (ADD) relative to the patient's expected maintenance dose on 2 consecutive prescriptions. The proportion of patients with dose escalation in the first 12 months after treatment initiation was determined. The magnitude of dose escalation was determined by calculating the patient's ADD across all noninduction dose claims and comparing it with the expected daily dose. Dose escalation prevalence and magnitude were used to quantify the equivalent patient treatment rate representing the number of patients per 100 that could have been treated with standard dosing, given the prevalence of dose escalation in the treated population. RESULTS: 7,028 patients (2,406 infliximab, 1,966 adalimumab, 1,745 vedolizumab, 472 ustekinumab, 285 certolizumab pegol, and 154 golimumab) met eligibility criteria and were included in the study. Among IBD therapies, dose escalation occurred most frequently with infliximab (39%), followed by adalimumab (28%), vedolizumab (23%), ustekinumab (22%), certolizumab pegol (20%), and golimumab (14%). The magnitude of dose escalation was greatest for ustekinumab (131%), followed by infliximab (70%), vedolizumab (62%), adalimumab (59%), certolizumab pegol (50%), and golimumab (45%). The calculated patient equivalence was highest for infliximab (128) and ustekinumab (128) compared with adalimumab (116), vedolizumab (114), certolizumab pegol (110), and golimumab (106).CONCLUSIONS: Among patients with IBD, dose escalation occurred with all TIMs examined with varying degrees of prevalence and magnitude. Realworld utilization patterns of TIMs indicate that dose escalation is an important part of the clinical management of IBD and needs to be considered when evaluating the cost-effectiveness of IBD treatments.

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“…[3][4][5][6] Sono stati presi in considerazione anche studi economici applicati specificamente alle IBD. [7][8][9][10][11][12] I costi sono stati suddivisi per le principali categorie di spesa: diagnostica di laboratorio e per immagini, farmaci, ricoveri ospedalieri, visite specialistiche. Ai valori in termini di risorse consumate sono stati associati i costi unitari, prezzi e tariffe specialistiche regionali in relazione alla risorsa specifica (ad esempio prezzi di acquisizione per farmaci e tariffe DRG per i ricoveri e per la diagnostica).…”

Section: Metodiunclassified

“…3–6 Sono stati presi in considerazione anche studi economici applicati specificamente alle IBD. 7–12…”

Section: Metodiunclassified

I costi dei pazienti con patologie infiammatorie dell’intestino (Malattia di Crohn e colite ulcerosa). Studio real world in Italia

Capri

Russo

2018

Global & Regional Health Technology Assessment

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La patologia infiammatoria dell'intestino (inflammatory bowel disease, IBD) indica due tipi di infiammazione cronica: l'enterite regionale, malattia di Crohn o colite granulomatosa (MC) e la colite ulcerosa (CU). Si tratta di due affezioni croniche a carattere flogistico, con decorso clinico altalenante caratterizzato da periodi di riacutizzazione e remissione dei sintomi. Il numero di malati in Italia può essere stimato tra 150.000 e 200.000 casi, con un'incidenza annua di circa 10.000 casi. La CU il MC possono manifestarsi a qualsiasi età, ma l'incidenza più elevata è tra i 20 e i 40 anni per la prima e tra i 15 e i 35 anni per la seconda. Uomini e donne ne sono egualmente colpiti, mentre è più alta l'incidenza nel nord Europa e

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Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis

Cited by 31 publications

References 32 publications

Golimumab: early experience and medium-term outcomes from two UK tertiary IBD centres

Golimumab: early experience and medium-term outcomes from two UK tertiary IBD centres

Dose Escalation Assessment Among Targeted Immunomodulators in the Management of Inflammatory Bowel Disease

I costi dei pazienti con patologie infiammatorie dell’intestino (Malattia di Crohn e colite ulcerosa). Studio real world in Italia

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