Early Intervention with Adalimumab May Contribute to Favorable Clinical Efficacy in Patients with Crohn's Disease

Abstract

Background: We evaluated the clinical efficacy of adalimumab (ADA) for Crohn's disease (CD) and analyzed predictive factors for clinical remission and long-term prognosis. Methods: We retrospectively reviewed the medical records of 45 patients treated with ADA for CD at Keio University Hospital between October 2010 and March 2014. Clinical remission was defined as a Harvey-Bradshaw index of ≤4. Results: Twenty-eight of 45 patients (62.2%) achieved clinical remission at week 4. Among these 28 patients, 18 patients (64.3%) maintained clinical remission at week 26, and among these, 16 patients (88.9%) maintained clinical remission at week 52. Absence of a history of bowel resection and absence of prior anti-tumor necrosis factor (anti-TNF) therapy were significant predictive factors for clinical remission at week 4 upon multivariate logistic regression analyses. Younger age and a disease duration of ≤3 years correlated with clinical remission at week 26 upon univariate analyses. Patients without a history of bowel resection showed significantly better long-term prognosis than those with a history of bowel resection (p = 0.01). None of the patients contracted a serious infectious disease. Conclusions: Younger age, shorter duration of disease, being naive to anti-TNF antagonists, and absence of a history of bowel resection were associated with the efficacy of ADA in CD patients.

Safety of Adalimumab and Predictors of Adverse Events in 1693 Japanese Patients with Crohn’s Disease

“…The results of previous studies have shown that adalimumab can be expected to be more effective in patients with short disease duration and in biological-naive CD patients. 21 …”

Management of Crohnʼs Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation

“…4 With better understanding of the disease immunobiology, and introduction of novel therapeutic modalities, the risk of CDassociated IF could be potentially reduced. 19,25,[30][31][32][33][34][35] Recent publications unfolded, for the first time, the interplay of autophagy and innate immunity as a key immunobiologic feature of CD, defining the disease as a polygenic immune disorder. 36,37 Of the recent therapeutic advances, are the introduction of immunosuppressive and immunomodulatory agents including anti-T-cell calcineurin inhibitors and humanized antibodies targeting tumor necrosis factor and integrin pathways.…”

“…36,37 Of the recent therapeutic advances, are the introduction of immunosuppressive and immunomodulatory agents including anti-T-cell calcineurin inhibitors and humanized antibodies targeting tumor necrosis factor and integrin pathways. 19,25,30,33,34,38 In addition, the traditional treatment strategy has been recently modified, adopting a step-up approach with mucosal healing being the primary therapeutic end point. 30 When surgery is indicated, utilization of meticulous, open, and laparoscopic surgical techniques with judicious surgical resection should be considered.…”

Early Initiation of Anti-TNF is Associated with Favourable Long-term Outcome in Crohn’s Disease: 10-Year-Follow-up Data from the Swiss IBD Cohort Study

“…The current literature favours a 'rapid step-up' strategy, with early, stepwise introduction of immunosuppressive agents (IM) and the timely addition of anti-TNF [11][12][13][14], although the benefit of early IM remains controversial [13,15]. The impact of a 'top-down' strategy, with early introduction of anti-TNF, including the key question, whether the disease's course can be modified through early anti-TNF administration has been investigated by even more studies [4,[16][17][18][19][20][21][22][23][24].…”