Introduction In 2010 NICE updated their guidelines on the prescription of anti-tumour necrosis factor alpha (a-TNF) for Crohn’s disease (CD) to include Adalimumab as a treatment for patients with severe active CD. As a therapeutic option it provided an attractive alternative, both to units, struggling for infusion capacity and limited specialist nurse input, and to patients, as a time-saving, home delivered and administered option.
Methods A retrospective review of inflammatory bowel disease patients at University Hospital North Staffordshire up until December 2012.
Results Of 3600 inflammatory bowel disease 117 patients are on a-TNF. A further 47 patients have had, but are no longer on, a-TNF. 37 patients had their original a-TNF switched during their disease course (21%). 25 patients (68% of all switches) had their a-TNF switched for non-clinical reasons (*including patient choice and unit preference). All of these were from infliximab to adalimumab, 8 had to be switched back to infliximab.
Prior to switching 23 of the 25 patients were in clinical remission with the other 2 being partial responders. After switching 11 remained in clinical remission, 13 did not have clinical remission and the data was unavailable in 1 patient.
Conclusion The revision of NICE guidelines to include adalimumab was associated with a significant percentage of *non-clinical switches. There was a 52% loss of efficacy in non-clinical switches. Loss of efficacy when switching has been confirmed in prospective trials.1,2
Hoentjen F, Haarhuis BJ, Drenth JP, de Jong DJ. Elective switching from infliximab to adalimumab in stable Crohn’s disease. Inflamm Bowel Dis 2013:19:761–6
Van Assche G, Vermeire S, Ballet V, Gabriels F, Noman M, D’Haens G, Claessens C, Humlet E, Vande Casteele N, Gils A, Rutgeerts P. Switch to adalimumab in patients with Crohn’s disease controlled by maintenance infliximab: prospective randomised SWITCH trial. Gut 2012:61:229–34
Disclosure of Interest None Declared.