{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:59:37Z","timestamp":1787068777396,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Dose escalation has been commonly used to achieve and maintain response. We aimed to compare the outcomes of adalimumab or infliximab dose escalation in inflammatory bowel disease (IBD) patients. Methods: Treatment persistence (TP) and predictive factors for remission-free treatment discontinuation (r-fTD) were evaluated in patients treated with adalimumab or infliximab dose escalation between 2019 and 2024. Results: Dose escalation was identified in 142 patients treated with adalimumab (UC: 23.9%; CD: 76.1%) and in 126 patients treated with infliximab (UC: 23.8%; CD: 76.2%). The TP rate was significantly lower in the adalimumab group (35.2%) than the infliximab group (53.2%) (p = 0.003). The survival analysis showed that drug persistence was lower in the adalimumab group compared with the infliximab group (mean time: 74.3 vs. 99.5 months, p &lt; 0.001). TP rates showed no significant differences between UC and CD for both adalimumab (mean time UC: 64.7 months vs. CD: 76.2 months, p = 0.403) and infliximab (mean time UC: 80.3 months and CD: 102.6 months, p = 0.151). The r-fTD rates were significantly higher in the adalimumab group (62.7%) than the infliximab group (39.7%) (p &lt; 0.001). Primary lack of response and secondary loss of response (sLOR) rates were both higher in the adalimumab group (7.7% and 51.4%) than the infliximab group (1.6% and 28.6%). However, serious adverse events were lower in the adalimumab group (2.1%) than the infliximab group (7.9%) (p = 0.027). Conclusions: Infliximab dose escalation was more effective than adalimumab in both UC and CD patients. Regarding the side effect profile, adalimumab dose escalation was found to be safer compared with infliximab.<\/jats:p>","DOI":"10.3390\/jcm14041228","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T04:03:35Z","timestamp":1739419415000},"page":"1228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Outcomes of Adalimumab and Infliximab Dose Escalation in Inflammatory Bowel Disease Patients Failing First-Line Biologic Treatment"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6488-8289","authenticated-orcid":false,"given":"Ali","family":"Atay","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-9914","authenticated-orcid":false,"given":"Yavuz","family":"Cagir","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, 06370 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mucahit","family":"Ergul","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1558-8882","authenticated-orcid":false,"given":"Oguz","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9047-6122","authenticated-orcid":false,"given":"Muhammed Bahaddin","family":"Durak","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilhami","family":"Yuksel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey"},{"name":"Department of Gastroenterology, School of Medicine, Ankara Yildirim Beyazit University, 06800 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1097\/MCG.0000000000000660","article-title":"World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease: Update August 2015","volume":"50","author":"Bernstein","year":"2016","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1093\/ibd\/izz078","article-title":"Challenges in IBD Research: Precision Medicine","volume":"25","author":"Denson","year":"2019","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1136\/gutjnl-2019-320065","article-title":"Big Data in IBD: Big Progress for Clinical Practice","volume":"69","author":"Madgwick","year":"2020","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s00535-017-1324-3","article-title":"Systematic Review with Meta-Analysis: Loss of Response and Requirement of Anti-TNF\u03b1 Dose Intensification in Crohn\u2019s Disease","volume":"52","author":"Qiu","year":"2017","journal-title":"J. Gastroenterol."},{"key":"ref_5","first-page":"274","article-title":"Anti-TNF Dose Escalation and Drug Sustainability in Crohn\u2019s Disease: Data from the Nationwide Administrative Database in Hungary","volume":"52","author":"Kunovszki","year":"2020","journal-title":"Dig. liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2036.2011.04679.x","article-title":"Review Article: Causative Factors and the Clinical Management of Patients with Crohn\u2019s Disease Who Lose Response to Anti-TNF-\u03b1 Therapy","volume":"34","author":"Danese","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1016\/j.crohns.2014.05.007","article-title":"Crohn\u2019s Disease Outpatients Treated with Adalimumab Have an Earlier Secondary Loss of Response and Requirement for Dose Escalation Compared to Infliximab: A Real Life Cohort Study","volume":"8","author":"Ma","year":"2014","journal-title":"J. Crohns. Colitis"},{"key":"ref_8","first-page":"656","article-title":"Etiology and Management of Lack or Loss of Response to Anti-Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease","volume":"15","author":"Fine","year":"2019","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1053\/j.gastro.2017.07.031","article-title":"American Gastroenterological Association Institute Technical Review on the Role of Therapeutic Drug Monitoring in the Management of Inflammatory Bowel Diseases","volume":"153","author":"Herfarth","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1080\/03007995.2017.1335001","article-title":"Dose Escalation of Biologics in Crohn\u2019s Disease: Critical Review of Observational Studies","volume":"33","author":"Einarson","year":"2017","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1080\/03007995.2019.1631058","article-title":"Dose Escalation and Switching of Biologics in Ulcerative Colitis: A Systematic Literature Review in Real-World Evidence","volume":"35","author":"Gemayel","year":"2019","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ecco-jcc\/jjw168","article-title":"3rd European Evidence-Based Consensus on the Diagnosis and Management of Crohn\u2019s Disease 2016: Part 1: Diagnosis and Medical Management","volume":"11","author":"Dignass","year":"2017","journal-title":"J. Crohns. Colitis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/ecco-jcc\/jjab178","article-title":"ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment","volume":"16","author":"Raine","year":"2022","journal-title":"J. Crohns. Colitis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/ecco-jcc\/jjz180","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Medical Treatment","volume":"14","author":"Torres","year":"2020","journal-title":"J. Crohns. Colitis"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1093\/ecco-jcc\/jjx009","article-title":"Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management","volume":"11","author":"Harbord","year":"2017","journal-title":"J. Crohns. Colitis"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1136\/gut.2005.082909","article-title":"The Montreal Classification of Inflammatory Bowel Disease: Controversies, Consensus, and Implications","volume":"55","author":"Satsangi","year":"2006","journal-title":"Gut"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S2468-1253(19)30012-3","article-title":"Predictors of Anti-TNF Treatment Failure in Anti-TNF-Naive Patients with Active Luminal Crohn\u2019s Disease: A Prospective, Multicentre, Cohort Study","volume":"4","author":"Kennedy","year":"2019","journal-title":"lancet. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1093\/ecco-jcc\/jjw067","article-title":"Long-Term Outcome of Patients with Ulcerative Colitis and Primary Non-Response to Infliximab","volume":"10","author":"Papamichael","year":"2016","journal-title":"J. Crohns. Colitis"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"667","DOI":"10.5009\/gnl230291","article-title":"Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure","volume":"18","author":"Bae","year":"2024","journal-title":"Gut Liver"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1093\/ecco-jcc\/jjv115","article-title":"Higher Rates of Dose Optimisation for Infliximab Responders in Ulcerative Colitis than in Crohn\u2019s Disease","volume":"9","author":"Stempak","year":"2015","journal-title":"J. Crohns. Colitis"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1093\/ibd\/izac200","article-title":"Systematic Review and Meta-Analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis","volume":"29","author":"Savelkoul","year":"2023","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1159\/000521299","article-title":"Retrospective Database Analysis: Dose Escalation and Adherence in Patients Initiating Biologics for Ulcerative Colitis","volume":"40","author":"Long","year":"2022","journal-title":"Dig. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"otad061","DOI":"10.1093\/crocol\/otad061","article-title":"Dose Escalation of Biologics in Biologic-Na\u00efve Patients With Ulcerative Colitis: Outcomes From the ODESSA-UC Study","volume":"5","author":"Ghosh","year":"2023","journal-title":"Crohn\u2019s Colitis 360"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1093\/ecco-jcc\/jjad203","article-title":"Biologic Therapy for Inflammatory Bowel Disease: Real-World Comparative Effectiveness and Impact of Drug Sequencing in 13 222 Patients within the UK IBD BioResource","volume":"18","author":"Kapizioni","year":"2024","journal-title":"J. Crohns. Colitis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1007\/s11096-020-00978-6","article-title":"Comparison of Drug Survival between Infliximab and Adalimumab in Inflammatory Bowel Disease","volume":"42","year":"2020","journal-title":"Int. J. Clin. Pharm."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1228\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:32:44Z","timestamp":1760027564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041228"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041228","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}