Efficacy and complications of adalimumab treatment for medically‐refractory Crohn’s disease: analysis of nationwide experience in Scotland (2004–2008)

Abstract

SUMMARY BackgroundAdalimumab is a second generation humanized anti-tumour necrosis factor (TNF) monoclonal antibody with established efficacy in Crohn's disease (CD).

Pre‐operative use of anti‐TNF‐α agents and the risk of post‐operative complications in patients with Crohn's disease – a nationwide cohort study

“…Previous studies have demonstrated the efficacy of antitumour necrosis factor-alpha (anti-TNF-a) agents (including infliximab and adalimumab) in patients with Crohn's disease (CD) [1][2][3][4] ; and thus infliximab has shown efficacy in the short-term treatment of refractory luminal and fistulising CD, 4,5 and also efficacy in a more longterm perspective. 1,[6][7][8] Since a number of patients will, however, require surgery after having anti-TNF-a agent therapy in the recent past, the surgeons will, therefore, be increasingly faced with abdominal surgery on CD patients with suppressed immune response in the preoperative setting and consequently concerns about an increased risk of post-operative complications.…”

Spontaneous free perforation of the small intestine in adults

“…In addition, rituximab, a novel monoclonal antibody agent used as a therapeutic option to deplete B-lymphocyte populations, was used to reportedly treat multiple distal ileal perforations in a patient with Wegener's granulomatosis [66] . A number of reports, noted above, have also recorded rare cases of free perforation in CD following anti-tumor necrosis factor (TNF) monoclonal antibody treatment [15][16][17] . Cases treated with either infliximab or adalimumab have been documented [15][16][17] .…”

“…A number of reports, noted above, have also recorded rare cases of free perforation in CD following anti-tumor necrosis factor (TNF) monoclonal antibody treatment [15][16][17] . Cases treated with either infliximab or adalimumab have been documented [15][16][17] . In one patient, free perforation developed after the initial dose of infliximab [16] .…”

“…In another treated with adalimumab, an ileal perforation was reported to be fatal [17] . In a case-control study from Amsterdam, a higher occurrence of free perforation in CD treated with TNF was evident compared to CD not treated with TNF [15] .…”

“…For example, use of wireless capsule and double-balloon endoscopic evaluations may cause small intestinal perforation in CD [13] while perforation has also been recorded after therapeutic balloon dilation of inflammatory and fibrous strictures [14] . In addition, adverse events, including fatal intestinal perforation, have been recorded in CD treated with different medications, including different emerging biological monoclonal antibody agents [15][16][17] .…”