Adalimumab Sustains Clinical Remission and Overall Clinical Benefit after 2 Years of Therapy for Crohn's Disease
R. Panaccione; J.-F. Colombel; W. J. Sandborn; P. Rutgeerts; G. R. D'Haens; A. M. Robinson; J. Chao; P. M. Mulani; P. F. Pollack
Authors and Disclosures
Alimentary Pharmacology & Therapeutics. 2010;31(12):1296-1309. © 2010 Blackwell Publishing
Abstract and Introduction
Abstract
Background In the randomized, double-blind, placebo-controlled CHARM trial, adalimumab was more effective than placebo in maintaining clinical remission for patients with moderate-to-severe Crohn's disease (CD) through 56 weeks.
Aim To substantiate the long-term safety and clinical benefits of adalimumab through 2 years of therapy in CHARM and its open-label extension (ADHERE).
Methods Patients entering ADHERE on blinded therapy received adalimumab 40 mg every other week (eow). Patients who had already moved to open-label adalimumab eow or weekly in CHARM continued their regimens. Data were analysed by originally randomized treatment group at CHARM baseline (adalimumab 40 mg eow, adalimumab 40 mg weekly, or placebo), regardless of whether patients entered ADHERE or received open-label adalimumab (eow or weekly).
Results After up to 2 years of therapy, 37.6%, 41.9% and 49.8% of patients originally randomized to placebo, adalimumab eow and adalimumab weekly, respectively, were in clinical remission. All groups experienced sustained improvements on the Inflammatory Bowel Disease Questionnaire. Decreasing hazard rates for both all-cause and CD-related hospitalizations were observed over time. Over a 2-year period, the rates of serious adverse events and malignancies (33.3 and 1.1 events/100-patient-years respectively) were similar to those observed during the overall adalimumab CD clinical development programme.
Conclusions Adalimumab demonstrated sustained maintenance of clinical remission, improvements in quality of life and reductions in hospitalization during long-term treatment for CD, with no new safety concerns identified.
Introduction
Crohn's disease (CD) is a chronic, progressive, inflammatory condition of the gastrointestinal tract that frequently progresses to serious complications – fistulas, abscesses and strictures.[1] Such complications often require hospitalization and surgery for management, particularly for patients with moderate-to-severe disease. The tumour necrosis factor (TNF) antagonists, adalimumab and infliximab, have proven to be effective therapies for inducing and maintaining remission for up to 1 year in patients with CD.[2–6] Certolizumab pegol was recently approved in the United States for reducing signs and symptoms and maintaining clinical response in patients with CD based on 26-week clinical trial data.[7, 8] As CD is a chronic disease and evidence for the use of biological therapies earlier in the course of treatment is growing,[9, 10] data on the long-term efficacy and safety of TNF antagonists are of interest to prescribing physicians.
Long-term treatment goals in CD include maintaining remission; decreasing CD-related hospitalization and surgery; preventing complications, including fistulizing disease, extraintestinal manifestations and adverse effects of concomitant medications and improving health-related quality of life (HRQOL) and productivity. Patients with sustained remission have lesser risks of complications that require hospitalization and/or surgery for medical management[11–13] and the cost benefit of sustained remission has been established.[14, 15] A recent publication reported the fistula-healing efficacy and safety of adalimumab through 2 years of therapy in patients with fistulizing CD;[16] however, data on the overall CD response and remission beyond 1 year of therapy with TNF antagonists are limited.
Adalimumab is a fully human, anti-TNF monoclonal antibody effective for inducing and maintaining clinical response and remission in both anti-TNF-naïve and infliximab-experienced patients with moderate-to-severe CD.[4–6, 17] To substantiate further the published results of efficacy, safety and positive impact on hospitalization/surgery risk and quality of life through 1 year of double-blind maintenance therapy,[6, 12, 18, 19] we aimed to evaluate the longer term effects of adalimumab maintenance therapy during the CHARM (Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance) trial and its open-label extension (ADHERE, Additional Long-Term Dosing With HUMIRA to Evaluate Sustained Remission and Efficacy in CD). This analysis includes patients with moderate-to-severe CD who received up to 2 years of therapy with adalimumab and is an extension of previously published reports of the first year of treatment.[6, 18]
R. Panaccione; J.-F. Colombel; W. J. Sandborn; P. Rutgeerts; G. R. D'Haens; A. M. Robinson; J. Chao; P. M. Mulani; P. F. Pollack
Authors and Disclosures
Alimentary Pharmacology & Therapeutics. 2010;31(12):1296-1309. © 2010 Blackwell Publishing
Abstract and Introduction
Abstract
Background In the randomized, double-blind, placebo-controlled CHARM trial, adalimumab was more effective than placebo in maintaining clinical remission for patients with moderate-to-severe Crohn's disease (CD) through 56 weeks.
Aim To substantiate the long-term safety and clinical benefits of adalimumab through 2 years of therapy in CHARM and its open-label extension (ADHERE).
Methods Patients entering ADHERE on blinded therapy received adalimumab 40 mg every other week (eow). Patients who had already moved to open-label adalimumab eow or weekly in CHARM continued their regimens. Data were analysed by originally randomized treatment group at CHARM baseline (adalimumab 40 mg eow, adalimumab 40 mg weekly, or placebo), regardless of whether patients entered ADHERE or received open-label adalimumab (eow or weekly).
Results After up to 2 years of therapy, 37.6%, 41.9% and 49.8% of patients originally randomized to placebo, adalimumab eow and adalimumab weekly, respectively, were in clinical remission. All groups experienced sustained improvements on the Inflammatory Bowel Disease Questionnaire. Decreasing hazard rates for both all-cause and CD-related hospitalizations were observed over time. Over a 2-year period, the rates of serious adverse events and malignancies (33.3 and 1.1 events/100-patient-years respectively) were similar to those observed during the overall adalimumab CD clinical development programme.
Conclusions Adalimumab demonstrated sustained maintenance of clinical remission, improvements in quality of life and reductions in hospitalization during long-term treatment for CD, with no new safety concerns identified.
Introduction
Crohn's disease (CD) is a chronic, progressive, inflammatory condition of the gastrointestinal tract that frequently progresses to serious complications – fistulas, abscesses and strictures.[1] Such complications often require hospitalization and surgery for management, particularly for patients with moderate-to-severe disease. The tumour necrosis factor (TNF) antagonists, adalimumab and infliximab, have proven to be effective therapies for inducing and maintaining remission for up to 1 year in patients with CD.[2–6] Certolizumab pegol was recently approved in the United States for reducing signs and symptoms and maintaining clinical response in patients with CD based on 26-week clinical trial data.[7, 8] As CD is a chronic disease and evidence for the use of biological therapies earlier in the course of treatment is growing,[9, 10] data on the long-term efficacy and safety of TNF antagonists are of interest to prescribing physicians.
Long-term treatment goals in CD include maintaining remission; decreasing CD-related hospitalization and surgery; preventing complications, including fistulizing disease, extraintestinal manifestations and adverse effects of concomitant medications and improving health-related quality of life (HRQOL) and productivity. Patients with sustained remission have lesser risks of complications that require hospitalization and/or surgery for medical management[11–13] and the cost benefit of sustained remission has been established.[14, 15] A recent publication reported the fistula-healing efficacy and safety of adalimumab through 2 years of therapy in patients with fistulizing CD;[16] however, data on the overall CD response and remission beyond 1 year of therapy with TNF antagonists are limited.
Adalimumab is a fully human, anti-TNF monoclonal antibody effective for inducing and maintaining clinical response and remission in both anti-TNF-naïve and infliximab-experienced patients with moderate-to-severe CD.[4–6, 17] To substantiate further the published results of efficacy, safety and positive impact on hospitalization/surgery risk and quality of life through 1 year of double-blind maintenance therapy,[6, 12, 18, 19] we aimed to evaluate the longer term effects of adalimumab maintenance therapy during the CHARM (Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance) trial and its open-label extension (ADHERE, Additional Long-Term Dosing With HUMIRA to Evaluate Sustained Remission and Efficacy in CD). This analysis includes patients with moderate-to-severe CD who received up to 2 years of therapy with adalimumab and is an extension of previously published reports of the first year of treatment.[6, 18]