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There is clear benefit from combination therapy with infliximab and immunosuppressive drugs, but few data are available for adalimumab.
Dr Reenaers and colleagues from Belgium assessed the efficacy of adalimumab monotherapy and adalimumab plus immunosuppressive drugs for induction and maintenance therapy in Crohn's disease.
Retrospective study of patients with Crohn's disease treated with adalimumab in the United Kingdom or Belgium. Treatment periods were divided into 6-month semesters.  | | Successful induction was achieved in 83% of patients | | Alimentary Pharmacology & Therapeutics |
A combination therapy semester was defined as adalimumab plus immunosuppressive drugs for at least 3 months. Successful induction meant clinical response, a semester with flare as adalimumab dose escalation, starting steroids, perianal complication, or surgery. The team reported that adalimumab failure as adalimumab withdrawal for secondary loss of response or intolerance. The researchers report successful induction in 83% of patients, with no significant difference between adalimumab +IS and adalimumab monotherapy. The team included 562 semesters in 181 patients for maintenance analysis. Adalimumab plus immunosuppressive drugs was not associated with fewer semesters with flare, or with adalimumab failure. Nevertheless, combination therapy in the first semester was associated with a lower risk of adalimumab failure, and combination therapy beyond 6 months was associated with fewer semesters with flares.
Dr Reenaers' team concludes, "There may be a benefit from adalimumab plus immunosuppressive drugs combination therapy during the first semester of initiating adalimumab, with a slight decrease in adalimumab failure and lower need for adalimumab dosage escalation."
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