title: Efficacy of adalimumab in patients with Crohn's disease and failure to infliximab therapy: a clinical series.
abstract: BACKGROUND
  adalimumab, a human anti-TNF, is an effective induction and maintenance therapy for patients with moderate to severe Crohn's disease. It seems to be effective in patients with resistance to infliximab, too, though the experience is more limited.
  
  
  OBJECTIVE
  to evaluate the efficacy of adalimumab, in patients with Crohn's disease (CD) and failure to previous treatment with infliximab.
  
  
  METHODS
  twenty-five patients with CD and failure to previous treatment with infliximab were enrolled; they were treated with 160/80 (24 patients) and 80/40 (1 patient) induction doses. We analyze clinical response to treatment with adalimumab by the Crohn's disease Activity Index (CDAI) and plasma concentration of C-reactive protein (CRP), steroid sparing and complete fistula closure at week 48.
  
  
  RESULTS
  eighteen out of twenty-five patients (72%) achieved clinical remission (CDAI score < 150) at week 24 and 15/25 (60%) patients at week 48. There was a statistically significant difference(p < 0.01) in CRP serum levels from 21 to 8 mg/dl at week 48.Nine out of fifteen patients (60%) treated with corticosteroids were able to discontinue steroids. Three out of eleven patients (27%) with fistulizing Crohn's disease had complete fistula closure after the treatment. Seventy two percent of the patients (18/25) needed to increase adalimumab to weekly dose, in order to maintain clinical response. Five out of twenty-five patients (20%) had adverse events; two of them (8%) with serious adverse events (tuberculous meningitis and abdominal abscess) that forced the withdrawal of treatment.
  
  
  CONCLUSIONS
  according to these data, adalimumab provides a clinical and analytical improvement in patients with CD and failure to previous therapy with infliximab.
authors: Unit of Inflammatory Bowel Disease, Department of Gastroenterology, Hospital Universitario Virgen Macarena, Seville, Spain. rioga_patri@hotmail.com
authors: P
authors: P
authors: Cordero Ruiz
authors: C
authors: C
authors: Castro Márquez
authors: V
authors: V
authors: Méndez Rufián
authors: L
authors: L
authors: Castro Laria
authors: A
authors: A
authors: Caunedo Álvarez
authors: J
authors: J
authors: Romero Vázquez
authors: J M
authors: JM
authors: Herrerías Gutiérrez
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004198:Disease Susceptibility; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine; D011241:Prednisone; D008727:Methotrexate