title: Efficacy and safety of adalimumab after infliximab failure in pediatric Crohn disease.
abstract: OBJECTIVE
  The objective of the present study was to evaluate the effectiveness and safety of adalimumab (ADA) in children with Crohn disease (CD) who experienced infliximab (IFX) failure at the population level.
  
  
  METHODS
  The present retrospective study included all of the children with CD from a pediatric-onset population-based cohort who received ADA before 18 years because of IFX failure or intolerance. Efficacy of ADA was evaluated using the physician's global assessment score, C-reactive protein and orosomucoid, and nutritional and growth indicators.
  
  
  RESULTS
  A total of 27 children with CD received ADA. Median age at CD diagnosis and at ADA initiation was 11 years (Q1 = 9; Q3 = 12) and 15 years (12; 15), respectively. After a median follow-up of 16 (8; 26) months after ADA initiation, ADA had clinical benefit as measured by the physical global assessment score in 19 patients (70%). Cumulative probability of failure to ADA treatment was 38% at 6 months and 55% at 1 year. Eight patients had a primary failure (30%) and 5 of 19 (26%) a secondary failure to ADA. Furthermore, 11 patients (40%) experienced a total of 19 adverse effects. No serious adverse effects were observed and none resulted in ADA discontinuation. There was no significant change in growth and nutritional patterns during the study period, but we found a significant decrease in median C-reactive protein (15 mg/L [4; 44] vs 9 mg/L [3; 19]; P = 0.05) and orosomucoid (1.6 g/L [1.5; 2.6] vs 1.1 g/L [0.8; 1.9]; P = 0.001) from ADA initiation to maximal follow-up in patients responding to ADA.
  
  
  CONCLUSIONS
  In the present population-based cohort of pediatric-onset CD with IFX failure, treatment with ADA was safe and effective in two-thirds of patients.
authors.affiliation: *Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens †Pediatric Unit, Jeanne de Flandre Hospital ‡Epimad Registry, EA 2694, Biostatistic Unit, Université Lille Nord de France §Pediatric Unit, St Vincent Hospital, Lille ||Pediatric Unit, Rouen University and Hospital ¶Gastroenterology Unit, Rouen University and Hospital, Rouen, France #Icahn School of Medicine at Mount Sinai, New York, NY **Gastroenterology Unit, Inserm U954, Université de Lorraine, Nancy ††EPIMAD Registry, EA 2694, Biostatistic Unit Université Lille Nord de France, Lille, France.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Anne
authors.initials: A
authors.lastname: Jacob
authors.forename: Hélène
authors.initials: H
authors.lastname: Sarter
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.forename: Claire
authors.initials: C
authors.lastname: Spyckerelle
authors.forename: Olivier
authors.initials: O
authors.lastname: Mouterde
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002657:Child Development / Q000187:drug effects; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009752:Nutritional Status / Q000187:drug effects; D009961:Orosomucoid / Q000032:analysis; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D009961:Orosomucoid; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab