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5PSQ-055 Long-term effectiveness of adalimumab in second-line of biological therapy in ulcerative colitis and influence of the first-line treatment
  1. C Moreno Ramos,
  2. MD Gil-Sierra,
  3. MDP Briceño-Casado,
  4. E Ríos-Sánchez
  1. Hospital Universitario de Puerto Real, Farmacia Hospitalaria, Cádiz, Spain


Background and importance Ulcerative colitis (UC) presents high levels of tumour necrosis factor alpha (TNFα) in colonic mucosa. Poor response to retreatment with a second TNF antagonist agent (anti-TNF) has been suggested in patients refractory to first line treatment with an anti-TNF.

Aim and objectives To evaluate long-term effectiveness of adalimumab as second anti-TNF and influence of the first anti-TNF treatment in UC.

Material and methods A descriptive retrospective study was conducted in patients with UC treated with adalimumab as second anti-TNF (January 2013–July 2021). Variables recorded were: age, sex, previous anti-TNF, response to anti-TNF treatment, duration of therapy and Mayo clinic score (MCS). Effectiveness was evaluated by MCS at 6, 36 and 72 months. Clinical remission (R) was defined as MCS ≤2 points. Clinical response (CR) was a decrease of ≥3 points in MCS with respect to baseline. Lack of response (LOR) was defined as none of the above. Patients with LOR and treatment suspension in a certain week were assumed as LOR in subsequent weeks. Influence of effect of first anti-TNF was estimated using association between types of response to first and second anti-TNF. Primary non-response (PNR) to anti-TNF therapy was considered as LOR in induction period (before week 10 for infliximab and before week 4 for adalimumab). Secondary non-response (SNR) to anti-TNF treatment was defined as LOR after induction period.

Results Thirty-one patients were included (54.8% women). Median age was 43 (86–21) years. All patients received infliximab as first anti-TNF. Median adalimumab treatment duration was 18 (1–91) months. MCS at 6 months: 32.26% R, 19.36% CR and 48.38% LOR. MCS at 36 months: 25.80% R, 3.23% CR and 70.97% LOR. MCS at 72 months: 6.45% R, 3.23% CR and 90.32% LOR. Two patients with PNR to adalimumab (2/10, 20%) had PNR to first anti-TNF and 8 with PNR to adalimumab (8/10, 80%) presented SNR to first anti-TNF. All patients with SNR to adalimumab demonstrated SNR to first anti-TNF.

Conclusion and relevance Adalimumab as a second anti-TNF maintained more than a quarter of patients with UC in R at 36 months, but almost all patients lost effectiveness at 72 months. Adalimumab’s PNR was less frequent in patients with PNR to a first anti-TNF therapy than in those with SNR.

Conflict of interest No conflict of interest

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