{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:18:50Z","timestamp":1787818730734,"version":"build-2784847793"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Real\u2010world data on dose escalation\/de\u2010escalation in inflammatory bowel disease (IBD) are scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess the frequency, effectiveness and durability of escalation\/de\u2010escalation of infliximab, adalimumab, golimumab, vedolizumab and ustekinumab in IBD, and to identify factors influencing relapse and drug discontinuation and re\u2010escalation efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included patients from the ENEIDA registry of GETECCU who were exposed to biologics and analysed escalations\/de\u2010escalations. We assessed the impact of variables on durability, drug discontinuation and relapse after escalation\/de\u2010escalation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 19,720 patients on biologics, 5096 (26%) underwent dose escalation. Frequency of escalation per patient\u2010year was 5% (infliximab), 7% (adalimumab), 7% (golimumab), 10% (vedolizumab) and 12% (ustekinumab). Clinical remission was recaptured in 32%\u201349% of patients. Durability of escalation (24\u2009months) ranged from 66% to 88%. Drug discontinuation was associated with previous biologic exposure and disease duration (infliximab), monotherapy (adalimumab) and ulcerative colitis (ustekinumab). There were 669 de\u2010escalations. The frequency per patient\u2010year was 6%, 9%, 5%, 6% and 3% for infliximab, adalimumab, golimumab, vedolizumab and ustekinumab. Maintenance of remission after de\u2010escalation was observed in 75%\u2013100%. Durability of de\u2010escalation (12\u2009months) was 82%\u201390%. Factors associated with relapse were biologic exposure (infliximab) and age at de\u2010escalation (adalimumab). Re\u2010escalation benefited most patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the long term, some patients with IBD need biologic escalation, which frequently recaptures durable clinical remission. De\u2010escalation is feasible in some patients. Re\u2010escalation is generally effective after relapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70312","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T12:54:38Z","timestamp":1754657678000},"page":"93-108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Frequency and Effectiveness of Dose Escalation and De\u2010Escalation of Biologic Therapy in Inflammatory Bowel Disease: The\n                    <scp>RAINBOW<\/scp>\n                    \u2010\n                    <scp>IBD<\/scp>\n                    Study of\n                    <scp>ENEIDA<\/scp>"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3611-8994","authenticated-orcid":false,"given":"Cristina","family":"Rub\u00edn de C\u00e9lix","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Fuenlabrada  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Ricart","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Cl\u00ednic i Provincial, Institut D'investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), and CIBEREHD  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Dolores","family":"Mart\u00edn\u2010Arranz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de La Paz  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"de Francisco","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Central de Asturias and Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA)  Oviedo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Garc\u00eda\u2010Alonso","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario R\u00edo Hortega  Valladolid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7864-8187","authenticated-orcid":false,"given":"Francisco","family":"Mesonero","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Gomoll\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Cl\u00ednico Lozano Blesa  Zaragoza Spain"},{"name":"Department of Gastroenterology Instituto de investigaci\u00f3n Sanitaria de Arag\u00f3n (IIS) and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"de Castro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital \u00c1lvaro Cunqueiro  Vigo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Complejo Hospitalario Universitario de Canarias  La Laguna Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Garc\u00eda\u2010L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Miguel Servet, Instituto de investigaci\u00f3n Sanitaria de Arag\u00f3n (IIS)  Zaragoza Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Arias","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Burgos  Burgos Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9051-2581","authenticated-orcid":false,"given":"Miriam","family":"Ma\u00f1osa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Germans Trias i Pujol and Universitat Aut\u00f2noma de Barcelona, Badalona and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Reina Sof\u00eda, IMIBIC and UCO  C\u00f3rdoba Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-9663","authenticated-orcid":false,"given":"Xavier","family":"Calvet","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Parc Taul\u00ed Hospital Universitari, Institut D'investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT\u2010CERCA)  Sabadell Catalunya Spain"},{"name":"Departament de Medicina Universitat Aut\u00f2noma de Barcelona  Madrid Spain"},{"name":"CIBERehd, Instituto de Salud Carlos III  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carles","family":"Suria Bolufer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Cl\u00ednico de Valencia  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8233-9638","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9","family":"Casanova","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de La Princesa, Instituto de Investigaci\u00f3n Sanitaria Princesa (IIS\u2010Princesa), Universidad Aut\u00f3noma de Madrid (UAM), and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L\u00e1zaro","family":"P\u00e9rez\u2010Calle","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Fundaci\u00f3n de Alcorc\u00f3n  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital de la Santa Creu i Sant Pau  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Sierra\u2010Aus\u00edn","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Complejo Asistencial Universitario de Le\u00f3n  Le\u00f3n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Vera","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Puerta de Hierro  Majadahonda Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merc\u00e8","family":"Navarro\u2010Llavat","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Mois\u00e8s Broggi  Sant Joan Desp\u00ed Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufo","family":"Lorente","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General Universitario de Ciudad Real  Ciudad Real Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Piqueras","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitari Consorci Sanitari de Terrassa (CST)  Terrassa Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Rivero","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Marqu\u00e9s de Valdecilla and IDIVAL  Santander Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Guardiola","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitari Bellvitge  L'Hospitalet de Llobregat Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Esteve","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitari M\u00fatua Terrassa, University of Barcelona and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fuentes Coronel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Complejo Asistencial de Zamora  Zamora Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-4578","authenticated-orcid":false,"given":"Iago","family":"Rodr\u00edguez\u2010Lago","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Galdakao, Biobizkaia Health Research Institute  Galdakao Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel","family":"Ponferrada\u2010D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Infanta Leonor  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Ber","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital de San Jorge  Huesca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Tardillo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Nuestra Sra. de la Candelaria  Santa Cruz de Tenerife Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"M\u00e1rquez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital del Mar  Barcelona Spain"},{"name":"Institut Hospital del Mar D'investigacions M\u00e8diques (IMIM)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Carpio","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Complexo Hospitalario Universitario de Pontevedra  Pontevedra 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General de Granollers  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-4139","authenticated-orcid":false,"given":"Ana","family":"Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General Universitario Doctor Balmis e ISABIAL, Alicante and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Fe","family":"Garc\u00eda\u2010Sepulcre","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General Universitario de Elche  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Barreiro\u2010de Acosta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Cl\u00ednico Universitario de Santiago  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Mar\u00edn\u2010Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology IiSGM, Hospital Gregorio Mara\u00f1\u00f3n Medicine Faculty, Complutense University  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 M.","family":"Huguet","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General Universitario de Valencia  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Ignacio","family":"Fern\u00e1ndez\u2010Salazar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Cl\u00ednico Universitario de Valladolid  Valladolid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordina","family":"Ja\u00f3","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Althaia Xarxa Assistencial Universitaria de Manresa  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Rodr\u00edguez\u2010Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Navarra, IdisNA  Navarra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Mart\u00ednez\u2010Flores","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General La Mancha Centro  Alc\u00e1zar de San Juan Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Bujanda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Biogipuzkoa Health Research Institute, Universidad del Pa\u00eds Vasco (UPV\/EHU), San Sebasti\u00e1n and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-1072","authenticated-orcid":false,"given":"Alfredo J.","family":"Lucendo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General de Tomelloso  Ciudad Real Spain"},{"name":"Department of Gastroenterology Instituto de Investigaci\u00f3n Sanitaria de Castilla\u2010La Mancha (IDISCAM) and CIBEREHD  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Ses\u00e9","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitari Arnau de Vilanova  Lleida Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Robledo Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de C\u00e1ceres  C\u00e1ceres Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ginard","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Son Espases  Palma de Mallorca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Vega","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Complexo H. Universitario de Ourense  Ourense Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Riera","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Son Ll\u00e0tzer  Manacor Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Pajares","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Infanta Sof\u00eda, Faculta de Medicina, Universidad Europea de Madrid  San Sebasti\u00e1n de los Reyes Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Van Domselaar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Torrej\u00f3n, Universidad Francisco de Vitoria  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Almela","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital General de Castell\u00f3  Castell\u00f3n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Mart\u00ednez P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Virgen de La Luz  Cuenca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Mu\u00f1oz\u2010Villafranca","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital de Basurto  Bilbao Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Varela","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario de Cabue\u00f1es  Asturias Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Arg\u00fcelles\u2010Arias","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla 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