Adalimumab in the Management of Crohn's Disease (CD) Patients with a Loss of Response to Infliximab

Category: Inflammatory Bowel Disease

Aims: Chimeric tumour necrosis factor (TNF) alpha antibody, infliximab, is an effective therapy for active CD. Patients may become unresponsive to this therapy over time. Aim: to determine the efficacy of adalimumab, a fully humanised anti-TNF-alpha antibody, in CD patients who lost response to infliximab.

Methods: In total, 107 CD patients were treated with infliximab of which 64% had a clinical response. Consecutive patients (n=13) who lost response to long-term infliximab management (3.2+0.7 years since first infusion) were treated with adalimumab. Study protocol comprised a loading dose of 80mg of adalimumab subcutaneously and 40mg every 2 weeks. Clinical response was defined as a drop of >70 points in Crohn's disease activity index (CDAI) and remission as CDAI <150.

Results: Overall, 69% (9/13) responded to adalimumab: 62% (8/13) had a clinical response and 1 patient (8%) went into remission. On follow up, at a median of 5.0 months, 62% (8/13) of patients maintained a clinical response. There were no significant adverse events, apart from a localised reaction at the site of infusion in one patient.

Conclusion: This study suggests that adalimumab is an effective option for the management of CD in patients who become unresponsive to infliximab therapy.