Does co-treatment with immunosuppressors improve outcome in patients with Crohn's disease treated with adalimumab?

Journal article

BACKGROUND: There is clear benefit from combination therapy with infliximab and immunosuppressive drugs (IS), but few data are available for adalimumab (ADA). AIM: To assess the efficacy of ADA monotherapy and ADA+IS for induction and maintenance therapy in Crohn's disease. METHODS: Retrospective study of patients with Crohn's disease treated with ADA in Oxford, UK or Liège, Belgium. Treatment periods were divided into 6-month semesters. A combination therapy semester was defined as ADA+IS for at least 3 months; successful induction meant clinical response; a semester with flare as ADA dose escalation, starting steroids, perianal complication, or surgery; and ADA failure as ADA withdrawal for secondary loss of response or intolerance. Semesters with and without flares were compared through univariate and multivariate analysis. RESULTS: Successful induction was achieved in 171/207 (83%) patients, with no significant difference between ADA+IS and ADA monotherapy (85% vs. 82%, P = 0.50). Five hundred and sixty-two semesters in 181 patients were included for maintenance analysis. ADA+IS was not associated with fewer semesters with flare (34% vs. 35%, P = 0.96), or with ADA failure (6% vs. 8%, P = 0.43). Nevertheless, combination therapy in the first semester was associated with a lower risk of ADA failure (5% vs. 10%, P = 0.04, OR = 0.48) and combination therapy beyond 6 months was associated with fewer semesters with flares (14% vs. 36%, P = 0.02, OR = 0.31). CONCLUSIONS: There may be a benefit from adalimumab+immunosuppressive drugs combination therapy during the first semester of initiating adalimumab, with a slight decrease in adalimumab failure and lower need for adalimumab dosage escalation.

Authors: Reenaers, C; Louis, E; Belaiche, J; Seidel, L; Keshav, S

• Publication status: Published
• Journal: Alimentary pharmacology and therapeutics
• Volume: 36
• Issue: 11-12
• Pages: 1040-1048
• Publication date: 2012-12-01
• DOI: 10.1111/apt.12076
• EISSN: 1365-2036
• ISSN: 0269-2813
• Language: English
• Keywords: Treatment Outcome; Antibodies, Monoclonal, Humanized; Belgium; Young Adult; Drug Therapy, Combination; Crohn Disease; Humans; Great Britain; Adult; Female; Male; Immunosuppressive Agents; Drug Administration Schedule; Tumor Necrosis Factor-alpha