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Background'Dose tailoring' of anti-tumour necrosis factor alpha (TNF-α) therapy in Crohn disease (CD), by dose escalation, or shortening of dosing intervals, has been suggested to regain clinical response following a flare in a proportion of patients. However, reported outcome data are sparse and none exists from Australia.MethodIn an observational multicentre, retrospective study, the impact of anti-TNF-α dose tailoring on corticosteroid use, the need for surgery and physician perception of clinical efficacy was examined in a real-world setting at six Australian adult teaching hospitals. Demographics, disease characteristics, medications, indication for and duration of dose tailoring were documented.ResultsFifty-five CD patients were identified as requiring dose tailoring and secondary loss of response was the indication in 96%. Either adalimumab (64%) or infliximab (36%) was dose escalated for a median of 5 months (range 1-47), with a median of 20 months follow up (range 3-65). At 3 months, dose tailoring reduced the mean number of days on high-dose corticosteroids (45 vs 23, P = 0.01). Most (78%) patients remained resection free, and 73% of physicians reported good clinical efficacy of dose tailoring. Of those who de-escalated therapy due to induction of remission, long-term (>12 months) follow up and complete data on steroid use were available in 15/28, with 12/15 (80%) remaining steroid free at 1 year.ConclusionShort-term dose tailoring regains disease response in the majority of patients with CD. Of these, most will remain free of corticosteroids at 1 year after de-escalating therapy.

Original publication




Journal article


Internal medicine journal

Publication Date





170 - 177


Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia; Centre for Inflammatory Bowel Disease, Fremantle Hospital, Fremantle, Western Australia, Australia.


AIBDA, Humans, Crohn Disease, Adrenal Cortex Hormones, Tumor Necrosis Factor-alpha, Antibodies, Monoclonal, Treatment Outcome, Remission Induction, Drug Administration Schedule, Severity of Illness Index, Analysis of Variance, Confidence Intervals, Logistic Models, Risk Assessment, Retrospective Studies, Cohort Studies, Follow-Up Studies, Maximum Tolerated Dose, Dose-Response Relationship, Drug, Adolescent, Adult, Aged, Middle Aged, Australia, Female, Male, Young Adult, Antibodies, Monoclonal, Humanized, Tertiary Care Centers, Adalimumab, Infliximab