The use of adalimumab in the management of refractory Crohn's disease.

Abstract:

BACKGROUND:Adalimumab is a humanized monoclonal antibody targeting tumour necrosis factor-alpha. Recent clinical trials have demonstrated its efficacy in Crohn's disease; however, experience in clinical practice remains limited. AIM:To investigate the efficacy and safety of adalimumab in the clinical setting. METHODS:The clinical outcomes of patients with medically refractory Crohn's disease treated with adalimumab in the Western General Hospital Edinburgh, over a 3-year period (2003-2006), were studied. RESULTS:Twenty-two (14 females; age at therapy: 32.6 years) patients were treated using an 80/40 mg induction regimen followed by fortnightly 40 mg treatment. All had proven refractory/intolerant to corticosteroids and immunosuppression. Twenty patients had had previous infliximab infusions - of these eight (36%), six (27%), three (14%) had previous infusion reactions, no response and lost response to infliximab, respectively. Over a period of 1.0 years (IQR: 0.62-2.5), Kaplan-Meier analyses showed that 68% (seven nonresponders) were in clinical remission and 67% (five surgery - discounting oral CD) avoided further surgery for active disease. 59% required dose escalation to 40 mg weekly (0.55 years; IQR: 0.22-1.4). Three (50%) primary nonresponders to infliximab achieved remission. Two patients developed serious infective complications and one patient developed lung cancer. CONCLUSIONS:Adalimumab is efficacious in refractory Crohn's disease, with benefit observed in infliximab primary nonresponders. However, many patients require escalation of dosing regimen.

journal_name

Aliment Pharmacol Ther

authors

Ho GT,Smith L,Aitken S,Lee HM,Ting T,Fennell J,Lees CW,Palmer KR,Penman ID,Shand AG,Arnott ID,Satsangi J

doi

10.1111/j.1365-2036.2007.03583.x

subject

Has Abstract

pub_date

2008-02-15 00:00:00

pages

308-15

issue

4

eissn

0269-2813

issn

1365-2036

pii

APT3583

journal_volume

27

pub_type

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