OBJECTIVES : Inflammatory bowel disease (IBD) consists of ulcerative colitis (UC) and Crohn’s disease (CD). In clinical practice, patients often experience loss of response to treatment with biologics and require dose escalation (DE). This study sought to estimate the proportion of IBD patients who underwent DE when treated with adalimumab (ADA), infliximab (IFX), or vedolizumab (VDZ).

METHODS : Three cohorts of IBD (UC or CD) patients with at least 1 claim for ADA, IFX, or VDZ during the index period of May 1, 2016, to April 30, 2017, were identified in the Symphony Health Integrated Dataverse (https://symphonyhealth.prahs.com). Patients were followed up post-index (first date of biologic) until the end of 365 days, discontinuation, or switch (whichever occurred first). The proportion of patients with DE on ADA, IFX, or VDZ based on infusion interval or dosage strength was estimated. A chi-square test was used for pairwise comparisons of cohorts.

RESULTS : A total of 3365 patients (2211 ADA, 540 IFX, and 614 VDZ) were identified. VDZ-treated patients had significantly lower DE (overall: 17.9%, UC: 16.1%, CD: 19.5%) than the IFX cohort (overall: 40.2%, UC: 43.8%, CD: 37.7%; all P<0.0001 vs. VDZ) and DE similar to the ADA cohort (overall: 17.6%, UC: 20.0%, CD: 16.3%; all P>0.15 vs VDZ). Interval shortening to less than every 8 weeks was significantly higher in the IFX cohort (24.3%) than the VDZ cohort (17.9%; P<0.0082). There were no significant differences in DE between the VDZ and ADA cohorts.

CONCLUSIONS : This exploratory study provided insights about potential DE with ADA, IFX, and VDZ in real-world data that warrant further research and analysis accounting for clinical variables related to IBD in clinical practice.