Adalimumab therapy is associated with reduced risk of hospitalization in patients with ulcerative colitis.
OBJECTIVE
Adalimumab is effective for induction and maintenance of remission in patients with moderate to severe ulcerative colitis (UC). We assessed whether adalimumab, in addition to standard UC therapy, reduced the risk for hospitalization (from all causes, from complications of UC, or from complications of UC or the drugs used to treat it) and colectomy in patients with moderate to severe UC compared with placebo.


METHODS
Data were combined from patients that received induction therapy (a 160-mg dose followed by an 80-mg dose of adalimumab) or placebo in 2 trials (ULTRA 1 and ULTRA 2; n = 963). The risks of hospitalization and colectomy were compared between groups using unadjusted rates during the 8-week induction period, and patient-year-adjusted rates during 52 weeks. Statistical differences between groups were determined using the χ(2) method and Z score normal approximations. Numbers of hospitalizations were compared using Poisson regression with time offset.


RESULTS
Significant reductions in risk of all-cause, UC-related, and UC- or drug-related hospitalizations (by 40%, 50%, and 47%, respectively; P < .05 for all comparisons) were observed within the first 8 weeks of adalimumab therapy compared with placebo. Significantly lower incidence rates for all-cause (0.18 vs 0.26; P = .03), UC-related (0.12 vs 0.22; P = .002), and UC- or drug-related (0.14 vs 0.24; P = .005) hospitalizations were observed during 52 weeks of adalimumab therapy compared with placebo. Rates of colectomy did not differ significantly between patients given adalimumab vs placebo.


CONCLUSIONS
In patients with moderate to severe UC, the addition of adalimumab to standard of care treatment reduced the number of hospitalizations for any cause, as well as for UC-related and UC- or drug-related complications, compared with placebo. ClinicalTrials.gov numbers, NCT00385736 and NCT00408629.
Robarts Research Institute, University of Western Ontario, London, Ontario, Canada. Electronic address: bfeagan@robarts.ca.
Brian G
BG
Feagan
Division of Gastroenterology, University of California San Diego, La Jolla, California.
William J
WJ
Sandborn
AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.
Andreas
A
Lazar
AbbVie Inc., North Chicago, Illinois.
Roopal B
RB
Thakkar
AbbVie Inc., North Chicago, Illinois.
Bidan
B
Huang
AbbVie Inc., North Chicago, Illinois.
Nattanan
N
Reilly
AbbVie Inc., North Chicago, Illinois.
Naijun
N
Chen
AbbVie Inc., North Chicago, Illinois.
Mei
M
Yang
AbbVie Inc., North Chicago, Illinois.
Martha
M
Skup
AbbVie Inc., North Chicago, Illinois.
Parvez
P
Mulani
AbbVie Inc., North Chicago, Illinois.
Jingdong
J
Chao
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab
Anti-TNF; CI; Colectomy; Inflammatory Bowel Disease; Randomized Placebo-Controlled Study; TNF; UC; confidence interval; eow; every other week; tumor necrosis factor; ulcerative colitis