Short-term response to adalimumab in childhood inflammatory bowel disease

Abstract

Adalimumab is effective for adults with moderate to severe Crohn's disease (CD). Data in children with inflammatory bowel disease (IBD) is sparse. We aim to evaluate pediatric IBD response to adalimumab. We conducted a retrospective chart review of pediatric IBD patients treated with adalimumab. We defined response as either a decrease in the disease activity index severity or remission after 3-6 months of treatment. Ten patients were identified. Seven had CD, three had ulcerative colitis (UC). All had colonic disease and disease in either the esophagus, stomach, or duodenum. Eight patients initially responded to infliximab, 5 with CD and 3 with UC; 2 CD patients had incomplete data for evaluation. The mean and median times between initial infliximab and initial adalimumab were 29.5 and 24 months, respectively. Eight patients responded to adalimumab 40 mg or 80 mg biweekly, or 80 mg initial dose followed by 40 mg biweekly. The mean Pediatric Crohn's Disease Activity Index (PCDAI) in CD patients before and after adalimumab were 12 and 4.2, respectively (normal <or=10). The mean Lichtiger Colitis Activity Index (LCAI) in UC patients before and after adalimumab were 9 and 5.1, respectively (normal <10). Corticosteroids were weaned off in 4/7 patients at 1 to 10 months after initiation of adalimumab. One patient with CD and 1 patient with UC failed adalimumab, required surgery, and remained on corticosteroids. Adalimumab is useful in pediatric IBD patients who become intolerant of infliximab.