Note from CCFA's National Scientific Advisory Committee: Similar effects are seen with other effective biologic therapy for Crohn's disease.

Adalimumab improves quality of life in Crohn's disease

Last Updated: 2008-12-22 12:25:14 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Adalimumab maintenance therapy improves quality of life for Crohn's disease patients, according to a report in the December issue of the American Journal of Gastroenterology.

"Medication is not just making a disease activity index number change -- that can be a bit obscure sometimes -- but it is resulting in significant improvements in fatigue, depression, and health-related quality of life," Dr. Edward V. Loftus from the Mayo Clinic in Rochester, Minnesota, told Reuters Health. "To my knowledge, this is the first trial demonstrating significant improvements in fatigue and depression scores in Crohn's disease by simply treating the inflammation."

In a study involving 499 Crohn's disease patients who had responded to adalimumab induction therapy, Dr. Loftus and colleagues used patient-reported outcome measures to evaluate the benefits of maintenance therapy in sustaining health-related quality of life improvements through week 56.

Patients who receive adalimumab maintenance therapy, especially those receiving injections every other week, were less likely to be depressed at week 56 than patients who had received adalimumab induction followed by placebo.

Furthermore, more patients in the adalimumab groups than in the placebo group showed additional improvement in physical and mental composite scores on the Short Form (SF)-36 health survey.

Adalimumab maintenance was also associated with lower reported fatigue scores, as well as improved mean scores on the Inflammatory Bowel Disease Questionnaire. While patients in the placebo group had worsening pain during the maintenance period, mean abdominal pain scores in the adalimumab patients improved, the researchers note.

"For future studies, we need more trials that examine bigger endpoints than just a change in Crohn's Disease Activity Index," Dr. Loftus said. "We need to examine 'harder' endpoints such as reduction in hospitalization and reduction in surgery."

"On the other hand, we need more studies that highlight the dramatic impact a chronic illness such as Crohn's disease can make on a person's life," Dr. Loftus added. "Since this condition often strikes people at a relatively young age, during their education or early career, while they're forming social relationships or getting married or starting a family, Crohn's can really completely change the 'trajectory' of a person's life. We are beginning to get a sense that some of these biologic agents, when used judiciously, can perhaps begin to normalize that altered trajectory."

Am J Gastroenterol 2008;103:3132-3141.