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Letter
Crohn's disease patients treated with adalimumab benefit from co-treatment with immunomodulators
  1. Mirthe E van der Valk1,
  2. Martijn G H van Oijen1,
  3. Marije Ammerlaan2,
  4. Peter D Siersema1,
  5. Bas Oldenburg1
  1. 1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2ApotheekZorg, Sittard, The Netherlands
  1. Correspondence to Dr Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; b.oldenburg{at}umcutrecht.nl

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We read with interest the study by Sokol et al in Gut, emphasising the need for co-treatment with immunomodulators in patients receiving infliximab maintenance therapy. Concomitant use of immunosuppressives was associated with reduced disease activity and infliximab dose escalation, presumably through a lowered frequency of antibody formation.1

Although adalimumab is a 100% human anti-tumour necrosis factor monoclonal antibody, it is not devoid of immunogenicity. Antibodies against adalimumab have been reported in 2.6–38% of patients treated for Crohn's disease or rheumatoid arthritis.2 However, the long-term efficacy of the combination of adalimumab plus immunosuppressives in this setting is not known. One observational study from Karmiris et al performed at …

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