Adalimumab for Crohn's disease in New Zealand--a prospective multicentre experience
Gareth R Thomas, Timothy Lewis-Morris, David Rowbotham
1Department of Medicine, University of Otago - Christchurch, PO Box 4345, Christchurch 8140, New Zealand. Richard.gearry@cdhb.govt.nz.
Insights
Adalimumab treatment for Crohn's disease in New Zealand shows high continuation rates and significant symptom improvement. This suggests it may be a preferred initial biologic therapy in the region.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Adalimumab is an established treatment for Crohn's disease (CD).
- Understanding early treatment patterns and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To describe early patterns of adalimumab use in New Zealand.
- To evaluate the efficacy and response to adalimumab in a New Zealand Crohn's disease cohort.
Main Methods:
- Prospective collection of Crohn's Disease Activity Index (CDAI) data.
- Analysis of adalimumab continuation rates and reasons for cessation.
- Examination of phenotypic characteristics and clinical outcomes.
Main Results:
- 194 patients were included with a mean follow-up of 20 months.
- High adalimumab continuation rates observed: 92.7% at 6 months, 67.4% at 30 months.
- Significant reduction in mean CDAI from 357 to 110 (p<0.0001) and hospital days (p<0.0001) after 6 months.
Conclusions:
- New Zealand's adalimumab continuation rate is higher than in other populations.
- Adalimumab may be more frequently used as an initial biologic therapy in New Zealand, contributing to higher continuation rates.
Aim:
Adalimumab is an effective treatment for Crohn's disease (CD). We aimed to describe the early patterns of use, efficacy and response to adalimumab in four regions of New Zealand.
Methods:
Prospectively collected CDAI data were used to examine adalimumab continuation rates in CD patients. Reasons for adalimumab cessation were determined and phenotypic characteristics of those remaining on adalimumab were examined.
Results:
194 patients (100 female) from four centres were included. Indications for adalimumab included CDAI>300 (59.8%), extensive small intestinal disease (21.1%), stoma with active disease (4.6%), risk of short gut syndrome (7.7%) and other (6.7%). The mean follow-up was 20 months (252.8 patient years of data). Adalimumab continuation rates at 6, 12, 24 and 30 months were 92.7%, 87.3%, 76.6% and 67.4%, respectively. Patients with penetrating disease behaviour were more likely to continue on adalimumab (p<0.005). There was a significant reduction in mean CDAI from 357 to 110 (p<0.0001) over a 6-month period. The mean (range) number of days spent in hospital per patient in the year prior and after adalimumab initiation were 3.5 (0-38) days and 1.9 (0-67) days, respectively (p<0.0001).
Conclusions:
Adalimumab continuation rate in this multicentre CD population was higher than other populations. This may be due to adalimumab being used more commonly as the initial biologic drug in New Zealand.
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