Adalimumab for Crohn's disease: long-term sustained benefit in a population-based cohort of 438 patients.
OBJECTIVE
Adalimumab is an effective therapy for induction and maintenance of Crohn's disease. However, results in clinical trials don't necessarily reflect daily clinical practice. Therefore, we assessed real-life long-term clinical response to adalimumab in a large population-based cohort and identified clinical parameters affecting response


METHODS
All consecutive patients in North-Holland that started adalimumab between 2003 and 2011 were included, of which medical charts were reviewed. Response to induction therapy was assessed after 3months. Sustained benefit of maintenance therapy was calculated from Kaplan-Meier survival tables depicting ongoing adalimumab treatment. Regression analyses were performed to identify factors predicting response to adalimumab therapy.


RESULTS
In total 438 Crohn's patients started adalimumab with 92.5% response to the induction phase. After 1year 83.3% showed sustained benefit of maintenance treatment, followed by 74.0% after 2years. Nevertheless, one third of patients were in steroid-free remission at the end of their follow-up. Response to induction was negatively affected by longer disease duration (OR 1.05; p<0.01) and strictures (OR 3.73; p=0.04). Increased CRP levels predicted higher rates of initial response (OR 0.31; p<0.01). Concomitant thiopurines in the first 6months of adalimumab treatment decreased the risk to fail maintenance therapy (HR 0.69, p=0.05). Previous infliximab therapy did not affect response to adalimumab, however dose escalation was more often deemed necessary (p<0.01).


CONCLUSIONS
Adalimumab was successful in the majority of patients, with 10% loss of response per subsequent year. Concomitant thiopurines might improve adalimumab maintenance treatment.
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands.
Charlotte P
CP
Peters
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands; Department of Surgery, Academic Medical Center, The Netherlands.
Emma J
EJ
Eshuis
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands.
Florien M
FM
Toxopeüs
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, The Netherlands.
Merel E
ME
Hellemons
Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, The Netherlands.
Jeroen M
JM
Jansen
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands.
Geert R A M
GR
D'Haens
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands.
Paul
P
Fockens
Department of Gastroenterology and Hepatology, St Lucas Andreas Hospital, The Netherlands.
Pieter C F
PC
Stokkers
Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, The Netherlands.
Hans A R E
HA
Tuynman
Department of Gastroenterology and Hepatology, Free University Medical Centre, The Netherlands.
Adriaan A
AA
van Bodegraven
Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands. Electronic address: C.Y.Ponsioen@amc.uva.nl.
Cyriel Y
CY
Ponsioen
D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab
Adalimumab; Cohort studies; Crohn's disease; Inflammatory bowel diseases; Infliximab; Thiopurines