OBJECTIVES: The use of tumor necrosis factor-alpha (TNF-alpha) antagonists has changed the therapeutic strategy for Crohn's disease (CD). Adalimumab (ADA), a fully human anti-TNF-alpha monoclonal antibody, is an effective therapy for patients with CD, both naive patients and those intolerant or refractory to Infliximab (IFX), a chimeric anti-TNF-alpha agent. However, the use of ADA is rarely reported in pediatric CD. We performed an open prospective evaluation of short-and long-term efficacy and safety of ADA in children with moderate-to-severe CD. METHODS: A total of 23 pediatric CD patients (9 naive and 14 intolerant or unresponsive to IFX) received ADA subcutaneously as a loading schedule at weeks 0 and 2, and at every other week (eow) during a 48-week maintenance phase. Loading and maintenance doses were 160/80 and 80 mg eow in 13 cases, 120/80 and 80 mg eow in 2, and 80/40 and 40 mg eow in 8 cases. The primary efficacy outcomes were clinical remission and response at different scheduled visits along the maintenance phase. At baseline, 13 patients also received immunomodulators (IMs). RESULTS: At weeks 2, 4, 12, 24, and 48, remission rates were 36.3, 60.8, 30.5, 50, and 65.2%, respectively, whereas response rates were 87, 88, 70, 86, and 91%, respectively. Four patients at week 24 and 2 at week 48 received IMs; the mean daily corticosteroid dose, disease activity index, C-reactive protein level, and erythrocyte sedimentation rate decreased significantly throughout the trial. No serious adverse events were recorded. CONCLUSIONS: ADA can be an effective and safe biological agent for inducing and maintaining remission in children with moderate-to-severe CD, even in those with previous IFX therapy.

Efficacy of adalimumab in moderate-to-severe pediatric crohn's disease / Viola, Franca; Civitelli, Fortunata; DI NARDO, Giovanni; Barbato, Maria; Conte, Francesca; Cucchiara, Salvatore; Borrelli, Osvaldo; Oliva, Salvatore. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - ELETTRONICO. - 104:10(2009), pp. 2566-2571. [10.1038/ajg.2009.372]

Efficacy of adalimumab in moderate-to-severe pediatric crohn's disease

VIOLA, Franca;CIVITELLI, FORTUNATA;DI NARDO, Giovanni;BARBATO, Maria;CONTE, FRANCESCA;CUCCHIARA, Salvatore;OLIVA, SALVATORE
2009

Abstract

OBJECTIVES: The use of tumor necrosis factor-alpha (TNF-alpha) antagonists has changed the therapeutic strategy for Crohn's disease (CD). Adalimumab (ADA), a fully human anti-TNF-alpha monoclonal antibody, is an effective therapy for patients with CD, both naive patients and those intolerant or refractory to Infliximab (IFX), a chimeric anti-TNF-alpha agent. However, the use of ADA is rarely reported in pediatric CD. We performed an open prospective evaluation of short-and long-term efficacy and safety of ADA in children with moderate-to-severe CD. METHODS: A total of 23 pediatric CD patients (9 naive and 14 intolerant or unresponsive to IFX) received ADA subcutaneously as a loading schedule at weeks 0 and 2, and at every other week (eow) during a 48-week maintenance phase. Loading and maintenance doses were 160/80 and 80 mg eow in 13 cases, 120/80 and 80 mg eow in 2, and 80/40 and 40 mg eow in 8 cases. The primary efficacy outcomes were clinical remission and response at different scheduled visits along the maintenance phase. At baseline, 13 patients also received immunomodulators (IMs). RESULTS: At weeks 2, 4, 12, 24, and 48, remission rates were 36.3, 60.8, 30.5, 50, and 65.2%, respectively, whereas response rates were 87, 88, 70, 86, and 91%, respectively. Four patients at week 24 and 2 at week 48 received IMs; the mean daily corticosteroid dose, disease activity index, C-reactive protein level, and erythrocyte sedimentation rate decreased significantly throughout the trial. No serious adverse events were recorded. CONCLUSIONS: ADA can be an effective and safe biological agent for inducing and maintaining remission in children with moderate-to-severe CD, even in those with previous IFX therapy.
2009
Adalimumab; Adolescent; Analysis of Variance; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Chi-Square Distribution; Child; Crohn Disease; Female; Humans; Injections; Male; Prospective Studies; Remission Induction; Severity of Illness Index; Treatment Outcome; Young Adult; Gastroenterology; Medicine (all)
01 Pubblicazione su rivista::01a Articolo in rivista
Efficacy of adalimumab in moderate-to-severe pediatric crohn's disease / Viola, Franca; Civitelli, Fortunata; DI NARDO, Giovanni; Barbato, Maria; Conte, Francesca; Cucchiara, Salvatore; Borrelli, Osvaldo; Oliva, Salvatore. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - ELETTRONICO. - 104:10(2009), pp. 2566-2571. [10.1038/ajg.2009.372]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/224587
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