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.