title: Adalimumab is effective in long-term real life clinical practice in both luminal and perianal Crohn's disease. The Madrid experience.
abstract: OBJECTIVE
  To evaluate effectiveness and safety of adalimumab in CD patients of the Madrid area and identify predictors of response.
  
  
  METHODS
  Multicenter retrospective survey of all CD patients treated with adalimumab in 9 hospitals of the Madrid area (Spain). Univariate and multivariate analysis of predictors of response was performed.
  
  
  RESULTS
  174 patients included (50% males) with a median follow-up of 40 weeks. 30% had active perianal fistulizing disease at the beginning of the therapy with adalimumab. 59% had been previously treated with infliximab, being the lost of response (42.2%) the most frequent cause of withdrawal of the drug. 33% of patients needed dose escalation from every-other week to every week. The median time for this dose escalation was 33 weeks (range 2-120). The percentages of complete response at 4 weeks, 6 months and end of follow-up were 63, 70 and 63% in luminal disease and 49, 50 and 41% in perianal disease respectively. The prevalence of adverse events was 18% (most frequent was: 5 abscesses) causing the withdrawal of the drug in 21% of them.
  
  
  CONCLUSIONS
  Adalimumab is effective and safe for the management of CD, even in refractory cases to infliximab.
authors: Digestive Disease Department, Hospital Gregorio Marañón, Madrid, Spain.
authors: José Ignacio
authors: JI
authors: Fortea-Ormaechea
authors: Yago
authors: Y
authors: González-Lama
authors: Begoña
authors: B
authors: Casis
authors: María
authors: M
authors: Chaparro
authors: Pilar
authors: P
authors: López Serrano
authors: Manuel
authors: M
authors: Van Domselaar
authors: Fernando
authors: F
authors: Bermejo
authors: Ramón
authors: R
authors: Pajares
authors: Angel
authors: A
authors: Ponferrada
authors: María Isabel
authors: MI
authors: Vera
authors: Pilar
authors: P
authors: Martínez Montiel
authors: Javier P
authors: JP
authors: Gisbert
authors: José Luis
authors: JL
authors: Pérez-Calle
authors: Antonio
authors: A
authors: López San Román
authors: Luis
authors: L
authors: Abreu
authors: Luis Alberto
authors: LA
authors: Menchén
authors: Ignacio
authors: I
authors: Marín-Jiménez
mesh_terms: D000038:Abscess / Q000139:chemically induced; D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017577:Cutaneous Fistula / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D012003:Rectal Fistula / Q000188:drug therapy; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D001379:Azathioprine