Survey regarding the use of adalimumab as maintenance therapy in Crohn’s disease in England and Ireland

Introduction: Adalimumab is effective in inducing and maintaining response/remission in patients with Crohn’s Disease (CD) either naive to biological therapies or following secondary failure of infliximab. Aim: To present the first ‘real-life’ survey data from England and Ireland on the use of adalimumab. Method: A retrospective audit conducted by a web-based questionnaire in England/Ireland. Results: We analysed data on 61 patients (35 female) with a median age of 33 years (range 17-71) with average follow-up of 8 months. Maximal maintenance dose was 40mg every other week in 84% of patients, 40mg weekly in 13% and 80mg weekly in 3%. Maintenance adalimumab achieved remission in 57% of patients. The ongoing response rate was 83.6%. An additional 8% had a secondary loss of response after average of 8.4 months (range 2-17). 23% had adverse effects, of which local pain 29%, infection 36%, headaches 14%, leucopenia (on AZA) 7%, a painful rash 7%, serum-sickness type reaction 7%. Adverse events led to discontinuation in 2 patients. Conclusion: This English/Irish audit show acceptable response/remission and safety profile of adalimumab in the treatment of CD. In contrast to previous data from Scotland, dose escalation was only seen in 16% of patients. The majority of responders were steroid-free at follow-up.