Systematic Review: the short- and long-term efficacy of adalimumab following discontinuation of infliximab.Ma C, Panaccione R, Heitman S, Devlin SM, Ghosh S, Kaplan GG. Aliment Pharmacol Ther. 2009 Jul 22. [Epub ahead of print] Abstract Background: Therapy with adalimumab has been shown to be effective in Crohn’s disease (CD) patients who have lost response or are intolerant to infliximab. Aim: A systematic review to determine the efficacy of adalimumab in CD patients who discontinued infliximab. Methods: Electronic searches of EMBASE and MEDLINE databases up to May 1, 2009, as well as abstracts from the AGA (2006-2008), ACG (2006-2007), UEGW (2006-2008), and CDDW (2006-2009) identified randomized-controlled trials (RCT) or open-labelled cohorts (OLC) evaluating the short- and/or long-term efficacy of adalimumab in infliximab failures. The response rate for short- (clinical response and remission at 4 weeks) and long-term (remission at 6 and 12 months) efficacy were considered. Results: A total of 1810 CD patients were identified among the 15 studies (2 RCT and 13 OLC). The majority evaluated CD patients who lost response or were intolerable to infliximab; though, 5 OLCs permitted patients refractory to infliximab. Short-term clinical response (n=9 articles) ranged from 41%-83%. Long-term clinical remission at 12 months (n=8 articles) ranged from 19%-68%. The occurrence of severe adverse events ranged from 0%-19% and 4 patients died. Conclusions: Current RCT and OLC evidence suggest adalimumab is an efficacious therapy for CD patients who discontinue infliximab.
