Adalimumab: a new tumor necrosis factor antagonist and the treatment of Crohn's disease.
Antibody-neutralization studies have implicated tumor necrosis factor-alpha (TNF-alpha) and IL-12 p40 in the pathogenesis of Crohn's disease (CD). Many randomized controlled trials (RCTs) have demonstrated the efficacy of infliximab, a chimeric monoclonal antibody to TNF, in inducing and maintaining disease remission in patients with moderate to severe CD, including those with draining fistulas. However, infliximab is administered intravenously and is associated with immunological reactions and development of antibodies, and hence reduced efficacy. In this article, we describe the efficacy and safety profiles of a newly available recombinant, fully humanized, subcutaneously-administered, anti-TNF-alpha monoclonal antibody, adalimumab (Humira) in patients with moderate to severe CD. Many recent RCTs have shown that adalimumab is not only similar to infliximab in the mode of action, efficacy, and safety, but it has the advantages of causing less anaphylactic or immunological reactions, being administered by the subcutaneous route, less need for hospitalization, and a half-life of 2 weeks that allows every other week dosage. Adalimumab has also shown some efficacy in infliximab-intolerant or resistant cases. Therefore, it represents a new horizon in the treatment of CD patients, and may reduce the number of patients who require surgical intervention.
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ahsalem10@hotmail.com
Ahmed
A
Helmy
Khalid
K
Al Kahtani