Adalimumab response prevents serious infections in CD

The risk of developing serious infections is much lower among patients with Crohn’s disease (CD) who showed response to adalimumab therapy than nonresponders, after accounting for disease severity, according to the results of a study presented at CCC 2024.

“These findings underscore that initiation of advanced therapy for CD may lower the risk of serious infections through effective disease control and avoidance of corticosteroids,” said the investigators led by Dhruv Ahuja, MD, Indira Ghandi Hospital, New Delhi, India.

A total of 1,515 patients with CD who were newly initiated to adalimumab therapy in the prospective PYRAMID registry and had complete data at 6 months were included in the present analysis.

Ahuja and his team classified these individuals as either treatment responders (achieved steroid-free clinical remission based on patient-reported outcomes) or nonresponders (not in steroid-free clinical remission) at 6 months after treatment initiation (landmark).

The risk of serious infections was then compared between responders and nonresponders between 6 to 36 months after treatment initiation via stabilized inverse probability of treatment weighted Cox proportional hazards model.

Of the eligible patients, 763 (50.4 percent) were classified as responders (mean age 37 years, 56 percent female, disease duration 9.5 years). [Ahuja, D, et al, CCC 2024]

At time of adalimumab initiation, responders exhibited a lower likelihood of having moderate to severe symptoms (55.6 percent vs 33.0 percent), needing steroids (45.5 percent vs 17.3 percent) or opiates (6.6 percent vs 1.3 percent), and having had prior CD-related surgery (46.5 percent vs 35.1 percent) than nonresponders, with no differences in disease location, perianal disease, and prior CD complications.

Some 123 patients had been inflicted with a total of 162 serious infections during follow-up between 6 and 36 months (observation period after landmark). Of these, 52 responders (6.8 percent) experienced a serious infection as compared with 71 nonresponders (9.4 percent). Notably, more than half of these infections (58 percent) were gastrointestinal in origin.

Serious infections

On stabilized inverse probability of treatment weighting through generalized boosting model, the risk of serious infections was lower by 34 percent among responders on follow-up as compared with nonresponders (hazard ratio [HR], 0.66, 95 percent confidence interval [CI], 0.46‒0.96).

However, no significant difference was noted in serious infections risk between nonresponders and responders based on organ site (gastrointestinal: HR, 0.61, 95 percent CI, 0.38‒0.99; extraintestinal: HR, 0.61, 95 percent CI, 0.46‒1.30; p=1.00 for difference in groups).

On follow-up, responders showed a significantly lower need for corticosteroids than nonresponders (1 year: 4.4 percent vs 50.7 percent; 2 years: 8.9 percent vs 51.6 percent; 3 years: 9.6 percent vs 51.0 percent). [CCC 2024, abstract S1]

“Patients with CD who respond to adalimumab have [a] lower risk of developing serious infections, compared with nonresponders, after accounting for disease severity,” according to Ahuja and his team.