A recent study demonstrated that in ulcerative colitis patients, adalimumab (a fully-humanized recombinant monoclonal antibody against tumor necrosis factor-α) might be considered as a treatment option irrespective of the reason for prior failure on infliximab.

Female gender, elevated C reactive protein (CRP)-level, and primary sclerosing cholangitis were important predictors of treatment failure. In contrast, older age at diagnosis and a low CRP-level were predictors of favorable short-term clinical response and drug survival.

A retrospective multicenter real-life cohort study was conducted in a large Swedish cohort to explore the short (three months) and long-term effectiveness, safety, and predictive factors of effectiveness of adalimumab. The study recruited 118 patients (59 males, 59 females, median age 34.4 years) having moderate to severe ulcerative colitis.

Retrospective capture of data from local registries at five Swedish Inflammatory bowel diseases (IBD) centers was done. After initiating adalimumab treatment, the clinical response and corticosteroid-free remission rates were evaluated at three months. The participants were followed until colectomy or requirement for another biological.

Bio-naive individuals were compared to bio-experienced individuals. Utilizing the logistic regression model, the factors linked with short term responses were determined. Utilizing a cox proportional hazards regression model, the failure on the drug was evaluated. The median disease duration was 4.3 years, and the participants were followed up for 1.27 years.

After three months, the no. of patients achieving clinical corticosteroid-free remission and response is depicted in the following table:

CRP >3 mg/l at baseline was predictive of short-term failure to attain corticosteroid-free remission. Male gender, CRP <3mg/l, and absence of primary sclerosing cholangitis were the factors linked with survival on the drug.

Compared to patients <20 years, the patients >42 years of age at diagnosis were more likely to respond to adalimumab therapy and remain on treatment. Prior infliximab failure, regardless of cause, did not influence the outcome of adalimumab treatment.

Thus, in patients with ulcerative colitis, adalimumab may be considered as a treatment option irrespective of the reason for prior failure on infliximab.