Crohn’s disease: early adalimumab improves clinical outcomes


  • Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with Crohn’s disease (CD), early administration (within 1 year of diagnosis) of adalimumab (ADA) improves clinical response and mucosal healing and reduces the loss of response rate and need for dose escalation.

Why this matters

  • Findings support the view that introducing ADA treatment during the “window period,” when structural alterations of the bowel are still not evident, may have a positive effect on the clinical history of the disease.

Study design

  • This retrospective study included 157 patients with CD who were treated with ADA with a disease duration of
  • Primary outcome: mucosal healing.
  • Secondary outcomes: clinical, deep and steroid-free remission, clinical response, endoscopic improvement and need for dose escalation.
  • Funding: SiCURA Soluzioni Innovative per la gestione del paziente e il follow up terapeutico della Colite UlceRosA” and other.

Key results

  • Early vs late administration group had a significantly higher rate of:
    • mucosal healing (53.75% vs 20.78%) and
    • clinical (66.25% vs 33.77%), deep (48.75% vs 19.48%) and steroid-free (88.75% vs 35.06%) remission (P<.001 for all>
  • A significant clinical response was observed in patients with disease duration >12 months (P= .02).
  • A higher proportion of patients in early vs late administration group showed endoscopic improvement (36.25% vs 16.88%; P=.006).
  • The need for dose escalation was lower in the early administration group than in the late administration group (30.0% vs 66.23%; P<.01>
  • At the end of follow-up, 7.50% patients were considered non-responders in the early administration group vs 22.08% in the late administration group (P=.01).

Limitations

  • Retrospective design.