A pilot study of adalimumab in infliximab-allergic patients.
The anti-TNF-alpha antibody infliximab (Remicade) is highly effective in the treatment of Crohn's disease. A subset of patients experience allergic reactions as a result of antibodies to infliximab (ATIs). The purpose of the current study is to describe the safety and efficacy of adalimumab (Humira) in patients previously allergic or intolerant to infliximab. Adalimumab is an anti-TNF-alpha agent containing only human peptide sequences. Seven patients have been treated with adalimumab who had experienced immediate- or delayed-hypersensitivity reactions to infliximab and one with infliximab-induced lupus. Except for injection site discomfort, adalimumab was well tolerated without signs or symptoms of allergic reactions. One patient who had previously received pooled human immunoglobulin developed a pruritic rash after each dose of adalimumab. Patients with active disease who had previously experienced a robust response to infliximab responded to adalimumab as reflected by an improvement in Harvey-Bradshaw index and inflammatory markers. Based on these preliminary data, adalimumab may be a safe and effective substitute for infliximab-allergic patients. Individuals who have been exposed to human antibodies may be sensitized to other human antibodies such as adalimumab.
Department of Medicine, Division of Gastroenterology, Inflammatory Bowel Disease Center, Los Angeles, CA 90048, USA.
Adrienne
A
Youdim
Eric A
EA
Vasiliauskas
Stephan R
SR
Targan
Konstantinos A
KA
Papadakis
Andrew
A
Ippoliti
Marla C
MC
Dubinsky
Juan
J
Lechago
Jane
J
Paavola
Jaime
J
Loane
Susie K
SK
Lee
Joanne
J
Gaiennie
Katie
K
Smith
Jason
J
Do
Maria T
MT
Abreu
D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003424:Crohn Disease / Q000188:drug therapy*; D004342:Drug Hypersensitivity; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects; D006801:Humans; D006968:Hypersensitivity, Delayed; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab