Patterns and factors associated with dose escalation during maintenance treatment for inflammatory bowel disease: a population-based cohort study.

BACKGROUND

Biologics and small-molecule therapies are commonly used for long-term maintenance in patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Dose escalation is often required to maintain treatment response, but real-world data on its frequency and contributing factors are limited.

OBJECTIVES

To evaluate patterns of dose escalation during maintenance treatment and identify patient- and treatment-related factors associated with dose escalation in IBD.

DESIGN

Retrospective, population-based cohort study.

METHODS

Using data from the Korean Health Insurance Review and Assessment Service (HIRA), we identified adults with CD or UC who initiated maintenance treatment with biologics or small-molecule agents between 2018 and 2022. Dose escalation was defined as two consecutive doses ⩾50% higher than the expected daily dose within 1 year of treatment initiation. Multivariable logistic regression was used to assess associated factors.

RESULTS

Among 2,186 patients with CD and 1,806 with UC, dose escalation occurred in 20.9% and 14.1%, respectively. In CD, ustekinumab had the highest escalation rate (69.1%), compared with infliximab (16.4%), adalimumab (21.2%), and vedolizumab (23.2%). For UC, adalimumab was most frequently escalated (21.8%), followed by tofacitinib (19.5%), ustekinumab (17.9%), and infliximab (10.0%). Steroid use, later lines of therapy (third- and fourth-line) were significantly associated with increased odds of dose escalation.

CONCLUSION

Dose escalation is a common occurrence in IBD maintenance therapy, with substantial variation across treatment agents and patient profiles. These findings emphasize the importance of individualized treatment strategies to improve long-term disease control.