Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 7, 2013; 19(17): 2676-2682
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2676
Clinical effects of adalimumab treatment with concomitant azathioprine in Japanese Crohn’s disease patients
Kumi Ishida, Takuya Inoue, Kaori Fujiwara, Taisuke Sakanaka, Ken Narabayashi, Sadaharu Nouda, Toshihiko Okada, Kazuki Kakimoto, Takanori Kuramoto, Ken Kawakami, Yosuke Abe, Toshihisa Takeuchi, Mitsuyuki Murano, Satoshi Tokioka, Eiji Umegaki, Kazuhide Higuchi
Kumi Ishida, Takuya Inoue, Kaori Fujiwara, Taisuke Sakanaka, Ken Narabayashi, Sadaharu Nouda, Toshihiko Okada, Kazuki Kakimoto, Takanori Kuramoto, Ken Kawakami, Yosuke Abe, Toshihisa Takeuchi, Mitsuyuki Murano, Satoshi Tokioka, Eiji Umegaki, Kazuhide Higuchi, the Second Department of Internal Medicine, Osaka Medical College, Takatsuki City, Osaka 569-8686, Japan
Author contributions: Ishida K and Inoue T performed data compilation, analysis, statistical analysis and manuscript preparation; Fujiwara K, Sakanaka T, Narabayashi K, Nouda S, Okada T, Kakimoto K, Kuramoto T, Kawakami K, and Abe Y has performed the adalimumab/adalimumab + azathioprine treatment; Takeuchi T, Murano M, Tokioka S, and Umegaki E assisted in the analysis and interpretation of data; Higuchi K and Umegaki E revised this manuscript.
Correspondence to: Takuya Inoue, MD, PhD, the Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka 569-8686, Japan. ureuretakuwan@yahoo.co.jp
Telephone: +81-72-6831221 Fax: +81-72-6846532
Received: December 20, 2012
Revised: January 17, 2013
Accepted: February 8, 2013
Published online: May 7, 2013
Processing time: 137 Days and 22 Hours
Abstract

AIM: To assess adalimumab’s efficacy with concomitant azathioprine (AZA) for induction and maintenance of clinical remission in Japanese Crohn’s disease (CD) patients.

METHODS: This retrospective, observational, single-center study enrolled 28 consecutive CD patients treated with adalimumab (ADA). Mean age and mean disease duration were 38.1 ± 11.8 years and 11.8 ± 10.1 years, respectively. The baseline mean Crohn’s disease activity index (CDAI) and C-reactive protein were 177.8 ± 82.0 and 0.70 ± 0.83 mg/dL, respectively. Twelve of these patients also received a concomitant stable dose of AZA. ADA was subcutaneously administered: 160 mg at week 0, 80 mg at week 2, followed by 40 mg every other week. Clinical response and remission rates were assessed via CDAI and C-reactive protein for 24 wk.

RESULTS: The mean CDAI at weeks 2, 4, 8, and 24 was 124.4, 120.2, 123.6, and 135.1, respectively. The CDAI was significantly decreased at weeks 2 and 4 with ADA and was significantly suppressed at 24 wk with ADA/AZA. Overall clinical remission rates at weeks 4 and 24 were 66.7% and 63.2%, respectively. Although no statistically significant difference in C-reactive protein was demonstrated, ADA with AZA resulted in a greater statistically significant improvement in CDAI at 24 wk, compared to ADA alone.

CONCLUSION: Scheduled ADA with concomitant AZA may be more effective for clinical remission achievement at 24 wk in Japanese Crohn’s disease patients.

Keywords: Crohn’s disease; Adalimumab; Immunomodulator; Azathioprine; Inflammatory bowel disease

Core tip: In this study, the authors found that adalimumab (ADA) treatment with concomitant azathioprine usage significantly suppressed the Crohn’s disease activity index and increased the remission rate at 24 wk after the initiation of therapy, compared with ADA treatment alone.