Gastroenterology Xagena

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Anti-TNF-naive Crohn's disease: clinical, biological, and endoscopic responses to Adalimumab and predictors of efficacy in clinical practice

Endoscopic healing and clinical remission are important parameters to evaluate therapeutic efficacy in Crohn's disease.
The aim of a study was to investigate the clinical effectiveness of Adalimumab ( Humira ) in terms of clinical and endoscopic response and to identify predictors of efficacy in clinical practice.

A prospective analysis was carried out of 68 antitumor necrosis factor-naive Crohn's disease patients treated with Adalimumab for 2 years.
Clinical and endoscopic response was assessed using the Harvey-Bradshaw index and the Simple Endoscopic Score for Crohn's disease, respectively.

Adalimumab treatment was associated with clinical remission in 76.6, 90.6, and 87.5% of patients at 6, 12, and 24 months. Loss of efficacy occurred in 17.6% of cases after 24 months of therapy.

Clinical remission with normal C-reactive protein at 2 months or with endoscopic response at 6 months was predictive of better outcomes.

Mucosal healing rates were 17.2, 44.7, and 39.5% and endoscopic responses were 55.1, 76.6, and 76.3% at the respective time points.

Mucosal healing was higher in the early treatment group than in the group with disease of at least 5 years' duration ( 64.7 vs. 19.1%, P=0.004 ).

Inflammatory phenotype showed a higher percentage of mucosal healing ( 70% ) than stricturing ( 29.4% ) or penetrating ( 27.3% ) disease.

In conclusion, Adalimumab was effective in providing sustained clinical remission.
In patients in clinical remission, the C-reactive protein level at 2 months, endoscopic response at 6 months, or inflammatory phenotype and short disease duration could be considered as good predictors of efficacy. ( Xagena )

Echarri A et al, Eur J Gastroenterol Hepatol 2015;27:430-435