Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease
L S Kiss, T Szamosi, T Molnar, P Miheller, L Lakatos, A Vincze, K Palatka, Z Barta, B Gasztonyi, A Salamon, G Horvath, G T Tóth, K Farkas, J Banai, Z Tulassay, F Nagy, M Szenes, G Veres, B D Lovasz, Z Vegh, P A Golovics, M Szathmari, M Papp, P L Lakatos, Hungarian IBD Study Group, L S Kiss, T Szamosi, T Molnar, P Miheller, L Lakatos, A Vincze, K Palatka, Z Barta, B Gasztonyi, A Salamon, G Horvath, G T Tóth, K Farkas, J Banai, Z Tulassay, F Nagy, M Szenes, G Veres, B D Lovasz, Z Vegh, P A Golovics, M Szathmari, M Papp, P L Lakatos, Hungarian IBD Study Group
Abstract
Background: Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD).
Aim: To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary.
Methods: Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients.
Results: Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation.
Conclusions: Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.
© 2011 Blackwell Publishing Ltd.
Source: PubMed