Perianal Fistulizing Crohn’s Disease: Higher Adalimumab Concentration Improves Healing

According to a story published on Healio, a recent study of patients living with Crohn’s disease that had resulted in a perianal fistula found that patients that maintained a concentration of adalimumab of at least 12.1 μg/mL achieved a higher healing rate than those that did not. The research team concluded that this threshold may be a useful target for therapeutic drug monitoring.

Patients experiencing perianal fistula (in which an abnormal passage is formed between the anal canal and the perianal skin) as a result of Crohn’s disease are experiencing an advanced and difficult to manage complication, with few treatment options. Anti-tumor necrosis factor (TNF) therapy such as adalimumab is essentially the only pharmacological approach. The retrospective study included a total of 183 patients with perianal fistulizing Crohn’s, with 82% having complex perianal fistula.

Median adalimumab concentration was 8.5 μg/mL. The primary outcome for this study was complete healing of the fistula, and the researchers were hoping to determine the ideal dosing level of the drug in order to promote healing. A total of 35% of the patients achieved completed healing and it was found that these patients had a higher concentration level of adalimumab than those that didn’t see complete healing.

The concentration of at least 12.1 μg/mL was the threshold at which patients had a higher healing rate, and this figure was independently associated with total healing of the fistula.

The study authors called for continued study to verify these findings. Check out the original study here.

About Crohn’s Disease

Crohn’s disease is a form of inflammatory bowel disease which can impact any area of the digestive tract. The cause of the illness is not well understood, but a combination of environmental, genetic, bacterial, and immune system factors could play a role; smoking tobacco appears to increase risk. The disease is often identified in the teen years or early adulthood. While abnormal immune system behavior is also present, it is not considered an autoimmune disease. Symptoms include weight loss, abdominal distension, bowel obstruction, diarrhea, fever, abdominal pain, fatigue, and inflammation spreading to other areas (eyes, joints, etc.). Patients are at an elevated risk of cancer impacting the digestive tract. Treatment includes changes to diet, stopping smoking, steroids, immunosuppressants, and certain surgical operations. Symptoms tend to relapse and remit, and some patients are able to live mostly normal lives. However, there is no cure for Crohn’s disease and treatment must continue for life. Patients have a slightly reduced life expectancy. To learn more about Crohn’s disease, click here.

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