A Pilot Study of Adalimumab in Infliximab-Allergic Patients

Abstract

The anti-TNF-alpha antibody infliximab (Remicade) is highly effective in the treatment of Crohn's disease. A subset of patients experience allergic reactions as a result of antibodies to infliximab (ATIs). The purpose of the current study is to describe the safety and efficacy of adalimumab (Humira) in patients previously allergic or intolerant to infliximab. Adalimumab is an anti-TNF-alpha agent containing only human peptide sequences. Seven patients have been treated with adalimumab who had experienced immediate- or delayed-hypersensitivity reactions to infliximab and one with infliximab-induced lupus. Except for injection site discomfort, adalimumab was well tolerated without signs or symptoms of allergic reactions. One patient who had previously received pooled human immunoglobulin developed a pruritic rash after each dose of adalimumab. Patients with active disease who had previously experienced a robust response to infliximab responded to adalimumab as reflected by an improvement in Harvey-Bradshaw index and inflammatory markers. Based on these preliminary data, adalimumab may be a safe and effective substitute for infliximab-allergic patients. Individuals who have been exposed to human antibodies may be sensitized to other human antibodies such as adalimumab.

Adalimumab for Crohn’s disease with intolerance or lost response to infliximab: a 3‐year single‐centre experience

“…A 4-week randomized placebo-controlled trial named GAIN (Gauging Adalimumab Efficacy in Infliximab Nonresponders) 9 and open-label trials [10][11][12] have demonstrated that adalimumab therapy was effective in inducing remission in patients with active CD who had previously responded to infliximab and then lost response or became intolerant. Several open-label trials 13,14 as well as an open-label extension study of the GAIN trial 15 suggested that adalimumab therapy may also be effective in maintaining clinical remission at 1 year in patients with CD who lost response or became intolerant to infliximab.…”

Pyoderma gangrenosum (1èrepartie) : mise au point

“…Les immunosuppresseurs, les immunomodulateurs ou les antimicrobiens ayant des propriétés anti-inflammatoires, comme la thalidomide [56,62,84], le mycophénolate mofétil [29], le tacrolimus [1][2][3]34], le méthotrexate [81], le cyclophosphamide [70], la dapsone [44], l'azathioprine [38], la clofazimine [54,55], la colchicine [47], les immunoglobulines intraveineuses [27], l'INFα [78], l'infliximab [38] et l'adalimumab [42,65,96], donnent des résultats satisfaisants lorsqu'ils sont utilisés comme traitements adjuvants ou en monothérapie pour les PG résistants aux corticostéroïdes. L'infliximab est acutellement considéré comme traitement de 1 ère intention chez les patients atteints simultanément d'un PG et d'une maladie intestinale inflammatoire chronique (recommandations de grade B) [69].…”

Crohn's Disease: current state of biological therapy

“…It is the third substance directed to TNF after infliximab and etanercept, and the second monoclonal developed for humans with the goal to act the same as the first, but with the likely advantage not to cause the unwanted effects of reaction to hypersensitivity 93,94 . thus, it is useful to treat CD in a patient who is "resistant" to infliximab 59 .…”