Adalimumab as second line anti-tumour necrosis factor alpha therapy for Crohn's disease: A single centre experience

Background and Aims: Non-response, loss of response, or intolerance to anti-tumour necrosis factor alpha (anti-TNF alpha) therapy is well recognised in Crohn's disease (CD) patients. Data concerning outcomes following the use of a second anti-TNF alpha therapy, particularly in patients who do not respond to a first anti-TNF alpha agent, are still emerging. The aim of this study was to assess response and tolerability to adalimumab following infliximab failure in a single centre cohort of CD patients. Methods: Data were collected prospectively on 44 patients who received adalimumab therapy following infliximab failure. Initial response to adalimumab therapy at 6 weeks following induction was defined using a two point decrease in the Harvey-Bradshaw Index, with remission at this point defined using a Harvey Bradshaw index <= 4. Sustained clinical benefit at the last point of follow up was determined using a physician's global assessment. Corticosteroid-free sustained clinical benefit was also assessed at this point. Results: Thirty-four (77%) patients had initial response to adalimumab therapy, with 28 (64%) having sustained clinical benefit. Corticosteroid-free sustained clinical benefit was achieved in nine (53%) of 17 patients requiring steroids at commencement of adalimumab. Four (44%) of the 9 patients who were primary non-responders to infliximab responded to adalimumab. The majority of CD patients who failed adalimumab therapy required surgery. Conclusions: Second-line anti-TNF alpha therapy with adalimumab is effective at both inducing remission and maintaining response in CD patients who have failed infliximab, regardless of the reason for infliximab failure. (C) 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.