TNF inhibitors are effective in the treatment of ulcerative colitis. Adalimumab ( Humira ), a fully human TNF inhibitor, is increasingly used both as primary anti-TNF agent and in patients switching from another TNF inhibitor due to treatment failure or side effects.
A study has investigated clinical outcomes of Adalimumab therapy in a clinical setting where Infliximab ( Remicade ) had been used as first choice of anti-TNF agent, and followed by Adalimumab as second line agent.
Retrospective, observational single-center cohort study including all ulcerative colitis patients treated with ADL at a tertiary Danish inflammatory bowel disease center until 2014.
Clinical outcomes were assessed after 12 and 52 weeks and classified according to physician's global evaluation ( PGE ).
The study population comprised 33 patients. Main reasons for switching from Infliximab to Adalimumab were infusion reactions to Infliximab ( 45% ) or Infliximab treatment failure ( 33% ).
Short-term efficacy of Adalimumab after 12 weeks revealed 15 patients ( 45% ) with clinical response, and 6 ( 18% ) in clinical remission.
Twenty-three patients continued Adalimumab for more than 12 weeks, and at long-term follow-up after 1 year of Adalimumab treatment, eight of these ( 34% ) had clinical response ( 24% of the entire cohort ) and six ( 26% ) were in clinical remission ( 18% of the entire cohort ).
A total of five patients ( 15% ) were colectomized mainly due to primary Adalimumab failure ( four of five patients ).
In conclusion, the efficacy of Adalimumab therapy in ulcerative colitis patients previously treated with Infliximab appears to be modest in clinical practice, and with higher colectomy rates than reported for anti-TNF-naive patients in the registration trials. ( Xagena )
Christensen KR et al, Scand J Gastroenterol 2015;50:1018-1024