Study Compares Clinical Outcomes of Adalimumab Dosing Intervals

Adalimumab, which is highly effective in treating Crohn disease (CD), works just as well if the interval between the doses is increased, according to a recent study published in the Lancet Gastroenterology and Hepatology.

“Patient’s living with CD often need lifelong medication,” the Dutch researchers wrote in the study paper. “Adalimumab is one of these treatments that is effective in inducing and maintaining remission. However, adalimumab is quite expensive and can lead to adverse effects, such as injection site reactions and increased incidence of infections.”

For this open-label, multicenter, randomized controlled trial, 174 adults from 20 hospitals in the Netherlands, diagnosed with luminal Crohn's disease were enrolled. All participants were on a biweekly, stable dose of subcutaneous 40 mg adalimumab.

The intervention group included 113 patients who underwent “increased adalimumab dose intervals of 40 mg every 3 weeks at baseline and further to every 4 weeks if they remained in clinical and biochemical remission at week 24.” The control group included 61 patients and continued their biweekly dosing.

The primary clinical outcome was the cumulative incidence of persistent flares at week 48.

The flares at week 48 were similar between both groups (3% for intervention group vs 0% for the control group; adjusted risk difference = 1.86%; 90% CI) However, the study highlighted that the intervention group was less likely to be in clinical and biochemical remission than the control group (72% vs. 92%; aRD = –16.1%; 95% CI, –31.3 to –0.91)

Increasing the duration between the doses of adalimumab among patients with CD and in stable remission did not seem to lead to more flares, at the same time presenting financial benefits by cutting down the cost of healthcare.

—Priyam Vora

Reference:
Linschoten R, Jansen F, Pauwels R et al. Increased versus conventional adalimumab dose interval for patients with Crohn’s disease in stable remission (LADI): a pragmatic, open-label, non-inferiority, randomized controlled trial. The Lancet Gastroenterol and Hepatol. 2023. 8(4): 343-355. DOI: https://doi.org/10.1016/S2468-1253(22)00434-4