University of Oulu

Tero Ylisaukko-oja, Minna Puttonen, Jari Jokelainen, Mirkka Koivusalo, Klaus Tamminen, Saku Torvinen & Markku Voutilainen (2022) Dose–escalation of adalimumab, golimumab or ustekinumab in inflammatory bowel diseases: characterization and implications in real-life clinical practice, Scandinavian Journal of Gastroenterology, 57:4, 415-423, DOI: 10.1080/00365521.2021.2014950

Dose–escalation of adalimumab, golimumab or ustekinumab in inflammatory bowel diseases : characterization and implications in real-life clinical practice

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Author: Ylisaukko-oja, Tero1,2; Puttonen, Minna3,4; Jokelainen, Jari1,2;
Organizations: 1MedEngine Oy, Helsinki, Finland
2Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
3Takeda Oy, Helsinki, Finland
4Division of Pharmaceutical Technology and Chemistry, Industrial Pharmacy, University of Helsinki, Helsinki, Finland
5Division of Medicine, Turku University Hospital, Turku, Finland
6Department of Medicine, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
Persistent link:
Language: English
Published: Informa, 2022
Publish Date: 2023-02-01


Objectives: Dose–escalation is a common practice to optimize treatment with subcutaneously administered biologicals in Crohn’s disease (CD) and ulcerative colitis (UC). However, limited data is available on the extent of dose-escalation in real-life. Here, we analyzed treatment persistence, dose–escalation, concomitant corticosteroid use, and costs of adalimumab, golimumab, and ustekinumab in inflammatory bowel diseases (IBD).

Methods: This was a nationwide, retrospective, non-interventional registry study. All adult patients who were diagnosed with CD or UC and had purchased adalimumab, golimumab, or ustekinumab from Finnish pharmacies between 2008 and 2018 were included in the study and followed up for 24 months after treatment initiation.

Results: A total of 2884 patients were included in the analyses. For adalimumab, treatment persistence was higher for CD patients compared to UC patients both at months 12 (46.2% versus 37.1%; p <.0001) and 24 (26.1% versus 19.7%; p < 0.0001). For golimumab (UC), treatment persistence was 48.3% at month 12 and 28.1% at month 24. The 12-month treatment persistence rate for patients on ustekinumab (CD) was 47.1%. Cumulative doses exceeding the regular dosing according to the summary of product characteristics (SPC), was observed for adalimumab in CD during the first 6 months of treatment (62.9% of the treatment periods), golimumab in the later stages of the UC treatment (52–54% of treatment periods at months 7–24), and ustekinumab during the first 6 months (70.7%).

Conclusions: Based on this study, dose–escalation of subcutaneously administered biologicals is a common clinical practice in IBD. This has implications for treatment costs, use of concomitant medications, and treatment outcomes.

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Series: Scandinavian journal of gastroenterology
ISSN: 0036-5521
ISSN-E: 1502-7708
ISSN-L: 0036-5521
Volume: 57
Issue: 4
Pages: 415 - 423
DOI: 10.1080/00365521.2021.2014950
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by Takeda Oy.
Copyright information: © 2021 Informa UK Limited, trading as Taylor & Francis Group. This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian Journal of Gastroenterology on 19 Dec 2021, available at: