Adalimumab Therapy in Children With Crohn Disease Previously Treated With Infliximab

Abstract

In clinical practice, adalimumab induces remission in two-thirds of children with IFX refractory CD.

Systematic review with meta‐analysis: the efficacy of a second anti‐TNF in patients with inflammatory bowel disease whose previous anti‐TNF treatment has failed

“…The literature search revealed 797 references in Pubmed and 1067 in Embase; however, some references were excluded, among other reasons, for duplication and non‐availability of data on the effectiveness of the second anti‐TNF . Finally, only 46 studies met the inclusion criteria and were included . Of these, 37 focused on CD (Tables S1 and S2), 8 on UC, and 1 on pouchitis (Table S3).…”

“…Studies were classified by type of IBD in order to pool data and perform the statistical meta‐analysis; therefore, the pouchitis study was excluded from the meta‐analysis. Of the CD studies, 32 evaluated switching from IFX to ADA, 4 switching from IFX to CZP, and 1 switching from ADA to IFX . All UC studies evaluated switching from IFX to ADA.…”

Adalimumab for the treatment of pediatric Crohn’s disease

“…De Bie et al [35] found no differences in remission or failure rates between patients who did and did not receive concomitant IMs at baseline (remission: 22 It should be emphasized that these retrospective cohort studies and the above-mentioned post hoc analysis are severely biased due to 'confounding-byindication', that is, patients with more severe disease may have been more likely on combination therapy, and thus even if combination therapy was more effective, it just leveraged the outcome to those of the milder patients on monotherapy.…”

“…In the relatively small pediatric studies on ADA use, serious or unusual infections were seen in 8 out of 290 (2.75%) patients: sepsis (n = 3), a severe case of Clostridium difficile, and abscess formation (n = 4) [23][24][25][26][31][32][33]35].…”

“…This retrospective analysis demonstrated that, after a median of 3.3 months, 64% of patients achieved clinical remission; 50% of these patients maintained such remission at 2 years of therapy. A sub-analysis evaluating differences according to the reason of IFX discontinuation, such as non-response or loss of response, showed that ADA was less effective in those patients who were primary non-responders to the previous anti-TNF-a, suggesting a different underlying disease pathway of inflammation in these patients [35]. In the retrospective studies, the overall ADA failure rate, where treatment failure was both a lack of efficacy (non-response or loss of response) and intolerance, ranged from 15 to 28% within the first year, and 20 to 42% within 2 years [25,35].…”