Dig Dis Sci. 2021 Aug;66(8):2744-2749. doi: 10.1007/s10620-020-06567-x.Epub 2020 Sep 16.

Stephane Paul ^1 2, Nicolas Williet ³, Stéphane Nancey ^4 5 6, Pauline Veyrard ³, Gilles Boschetti ^4 5 6, Jean-Marc Phelip ³, Bernard Flourie ^4 5 6, Xavier Roblin ^7 8 9

Author information

¹Faculty of Medicine of Saint-Etienne, Immunology Unit University hospital of saint Etienne, CIC INSERM 1408, Saint-Etienne, France.

²Groupe Immunité des muqueuses et Agents Pathogènes (GIMAP), INSERM U1111- International center for research in infectiology (CIRI), Saint-Etienne, France.

³Department of Gastroenterology, Saint-Etienne University hospital, Saint-Etienne, France.

⁴Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France.

⁵University Claude Bernard Lyon 1, Lyon, France.

⁶INSERM U1111- International center for research in infectiology (CIRI), Lyon, France.

⁷Groupe Immunité des muqueuses et Agents Pathogènes (GIMAP), INSERM U1111- International center for research in infectiology (CIRI), Saint-Etienne, France. xavier.roblin@chu-st-etienne.fr.

⁸Department of Gastroenterology, Saint-Etienne University hospital, Saint-Etienne, France. xavier.roblin@chu-st-etienne.fr.

⁹Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France. xavier.roblin@chu-st-etienne.fr.

Abstract

Introduction: The pharmacokinetic equivalence of dose intensification with adalimumab (ADA) 80 mg every other week (EOW) compared to weekly 40 mg has only been supported by modeling systems.

Aim of the study: To compare the trough levels of ADA (TLA) and the occurrence of anti-ADA antibodies (AAA) between these two treatment regimens.

Patients and methods: This was a prospective study including all consecutive patients with inflammatory bowel disease (IBD) who had reached a longstanding and deep remission under treatment with ADA 40 mg once a week. In these patients, the ADA regimen was changed from 40 mg/week to 80 mg EOW. TLA and AAA levels using a drug-tolerant assay were monitored before and ten weeks after from the change in the ADA regimen and the results compared by a Wilcoxon paired test.

Results: Sixty-two patients (60% CD, mean age 35 years) were included. Before and ten weeks after the changes of ADA regimen, the median TLA were (6.9 µg/mL versus 7.0 µg/mL, respectively; P = 0.34) and the AAA levels (3.4 µg/ml-eq versus 3.0 µg/ml-eq, respectively; P = 0.25.) were quite similar. Likewise, quartiles of TLA (Kendall test r = 0.91; P < 0.001) and AAA (r = 0.78; P < 0.001) did not differ before and after ADA regimen. When stratifying all the patients into 4 groups based on drug/antibody levels (immunogenic, subtherapeutic, therapeutic, or supratherapeutic), no patient needed for returning to the previous weekly regimen. In terms of acceptability, more than 60% of patients preferred an injection EOW compared once a week.

Conclusions: In IBD patients who achieved a deep clinical remission under ADA 40 mg once a week, the pharmacokinetic of ADA was similar when ADA regimen was changed to 80 mg EOW. Given the patient's preference for the latter regimen, a modification of injection regimen should be systematically proposed.