A practical, evidence-based guide to the use of adalimumab in Crohn’s disease

Abstract

Background:

Anti-tumor necrosis factor (anti-TNF) agents are important therapies for treating Crohn’s disease (CD) because they may induce and maintain remission, reduce the need for corticosteroids, decrease hospitalizations and surgeries, and heal the mucosa. Here we provide a practical, evidence-based guide to help clinicians optimize the use of adalimumab in patients with CD.

Scope:

A literature search in the MEDLINE, EMBASE, and BIOSIS databases was performed for articles published between 1996 and 2010 describing adalimumab use in CD. Abstracts presented at the ACG, DDW, UEGW, ECCO, and SGNA congresses, references from review articles and published randomized clinical trials, and the manufacturer’s prescribing information also were reviewed.

Findings:

When selecting an anti-TNF agent, factors such as efficacy, safety, immunogenicity, patient preference, and the timing and sequencing of therapies should be considered. Important considerations for patient management include dosage selection, use of combination therapy, timing of monitoring treatment response, and evaluation of recurrent CD symptoms in a previously responding patient. We recommend that patients initiating adalimumab receive a loading dose of 160/80 mg subcutaneously at Week 0/Week 2, followed by up to 8 weeks of 40 mg every-other-week maintenance therapy prior to determining if there is non-response. During therapy, recurrent or new symptoms should be fully evaluated to ensure that they are indeed related to underlying inflammation versus other causes (e.g., intercurrent infection, bile acid diarrhea, or irritable bowel). Patients experiencing attenuation of response or inflammatory-mediated symptoms during maintenance therapy may benefit from dosage intensification to weekly adalimumab.

Conclusion:

Considerations for the use of anti-TNF agents in CD, with an emphasis on adalimumab, are reviewed and practical patient management recommendations are presented.

Key words::

• Adalimumab
• Anti-TNF
• Crohn’s disease
• Induction
• Maintenance

Transparency

Declaration of funding

The analysis and editorial support for the manuscript were funded by Abbott Laboratories, Abbott Park, IL, USA.

Declaration of financial relationships

D.T.R. has received consulting fees from Abbott, Procter and Gamble (Warner Chilcott), Salix, Prometheus, UCB, Centocor, Elan, and Shire; has received research support from Procter and Gamble, Salix, and Prometheus Laboratories; and has served on the advisory board for UCB, Centocor, Elan, and Shire. R.P. has served as consultant for Abbott, AstraZeneca, Ferring, Schering-Plough, Shire, Centocor, Elan, Glaxo-Smith Kline, UCB, Proctor and Gamble, and Bristol-Myers Squibb; has served on the speakers bureau for Abbott, AstraZeneca, Byk Solvay, Axcan, Jansen, Schering-Plough, Shire, Centocor, Elan, Prometheus, and Proctor and Gamble; has served on the advisory board for Abbott, Ferring, Schering-Plough, Shire, Elan, and Proctor and Gamble; and has received research/educational support from Abbott, Ferring, Axcan, Jansen, Schering-Plough, Centocor, Millennium, Elan, Proctor and Gamble, and Bristol-Myers Squibb. J.C. and A.M.R. are employees of Abbott and hold stock in Abbott.

Acknowledgment

The authors would like to thank Cathryn M. Carter, MS, of Arbor Communications, Inc., Ann Arbor, Michigan, USA for assistance in the preparation of this manuscript. This support was funded by Abbott.

Notes

* REMICADE is a registered trade name of Centocor Inc., Malvern, PA, USA.

† HUMIRA is a registered trade name of Abbott Laboratories, Abbott Park, IL, USA.

‡ CIMZIA is a registered trade name of UCB Inc., Smyrna, GA, USA.