Adalimumab for Crohn's disease: Long-term sustained benefit in a population-based cohort of 438 patients

Abstract Background and aims Adalimumab is an effective therapy for induction and maintenance of Crohn's disease. However, results in clinical trials don't necessarily reflect daily clinical practice. Therefore, we assessed real-life long-term clinical response to adalimumab in a large population-based cohort and identified clinical parameters affecting response Methods All consecutive patients in North-Holland that started adalimumab between 2003 and 2011 were included, of which medical charts were reviewed. Response to induction therapy was assessed after 3 months. Sustained benefit of maintenance therapy was calculated from Kaplan–Meier survival tables depicting ongoing adalimumab treatment. Regression analyses were performed to identify factors predicting response to adalimumab therapy. Results In total 438 Crohn's patients started adalimumab with 92.5% response to the induction phase. After 1 year 83.3% showed sustained benefit of maintenance treatment, followed by 74.0% after 2 years. Nevertheless, one third of patients were in steroid-free remission at the end of their follow-up. Response to induction was negatively affected by longer disease duration (OR 1.05; p p  = 0.04). Increased CRP levels predicted higher rates of initial response (OR 0.31; p p  = 0.05). Previous infliximab therapy did not affect response to adalimumab, however dose escalation was more often deemed necessary ( p Conclusion Adalimumab was successful in the majority of patients, with 10% loss of response per subsequent year. Concomitant thiopurines might improve adalimumab maintenance treatment.