Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort

Background: Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Aim: To assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. Methods: We retrospectively reviewed the chart of 428 consecutive IBD patients started on adali-mumab between January 1,2015-January 1,2019 [338 Crohn's disease(CD), 90 ulcerative colitis(UC)]. Clin-ical symptoms(assessed by Harvey-Bradshaw-Index,partial Mayo),C-Reactive Protein(CRP), and fecal cal-protectin(FCAL) assessments were captured at treatment initiation and at 3,6,9, and12 months. Dose op-timization and drug sustainability curves were plotted by Kaplan-Meier method. Results: Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months(p = 0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose opti-mization in CD and UC patients(pLogrank = 0.026 for UC & p = 0.09 for CD). Overall drug sustainability did not differ. Conclusion: Clinical & CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Ad-herence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study retrospectively reviewed the charts of 428 consecutive IBD patients and found that clinical and CRP testing were frequently conducted, but adherence to serial FCAL testing was low. Adherence to early follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes for patients.