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Adalimumab therapy in children with Crohn disease previously treated with infliximab

Martinus Cozijnsen1, Vera Duif, Freddy Kokke

  • 1*Pediatric Gastroenterology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam †Pediatric Gastroenterology, Radboud University Nijmegen Medical Centre, Nijmegen ‡Pediatric Gastroenterology, Wilhelmina Children's Hospital-University Medical Center, Utrecht §Pediatric Gastroenterology, Emma Children's Hospital-Academic Medical Center, Amsterdam ||Pediatric Gastroenterology, Beatrix Children's Hospital-University Medical Center Groningen, Groningen ¶Pediatric Gastroenterology, VU University Medical Center, Amsterdam #Pediatric Gastroenterology, Willem-Alexander Kinderziekenhuis-Leiden University Medical Center, Leiden **Pediatric Gastroenterology, Isala Hospital, Zwolle ††Pediatric Gastroenterology, Catharina Hospital, Eindhoven ‡‡Pediatric Gastroenterology, Maastricht University Medical Center, Maastricht §§Pediatric Gastroenterology, Amphia Hospital, Breda ||||Pediatric Gastroenterology, Medisch Spectrum Twente, Enschede ¶¶Pediatric Gastroenterology, Gelre Hospitals, Apeldoorn, The Netherlands.

Journal of Pediatric Gastroenterology and Nutrition
|October 7, 2014
PubMed

Insights

Adalimumab effectively treats pediatric Crohn disease (CD) in children previously treated with infliximab (IFX). Two-thirds of patients achieved remission, demonstrating its clinical utility in refractory cases.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pediatric Medicine

Background:

  • Adalimumab, an anti-tumor necrosis factor antibody, is effective for adult refractory Crohn disease (CD).
  • Limited data exists on adalimumab's efficacy in pediatric CD patients.
  • Previous infliximab (IFX) therapy is common in pediatric CD management.

Purpose of the Study:

  • To evaluate the real-world efficacy of adalimumab in pediatric CD patients.
  • To compare adalimumab's effectiveness in IFX non-responders versus those who lost response to IFX.

Main Methods:

  • Retrospective analysis of Dutch pediatric CD patients (<18 years) treated with adalimumab post-IFX.
  • Disease activity assessed using weighted Pediatric Crohn's Disease Activity Index (wPCDAI) or physician global assessment (PGA).
  • Adverse events (AEs) were monitored.

Main Results:

  • 64% of 53 pediatric CD patients achieved remission (wPCDAI < 12.5 or PGA = 0) within a median of 3.3 months.
  • Remission was maintained by 50% for 2 years; 21% achieved partial response.
  • 34% failed adalimumab due to nonresponse, loss of response, or AEs. IFX non-responders had a significantly higher failure rate (HR 18.8).
  • Only one serious AE (nonfatal infection) was reported.

Conclusions:

  • Adalimumab is a viable treatment option for pediatric CD refractory to IFX.
  • The drug induces remission in approximately two-thirds of these patients in clinical practice.
  • Adalimumab demonstrates a favorable safety profile in this pediatric cohort.
Abstract

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