Adalimumab may be associated with improved outcomes in the management of pediatric Crohn’s disease

1. Maintenance therapy with adalimumab (ADA) was associated with more frequent objective improvement based on Magnetic Resonance Enterography (MRE) findings than immunomodulator (IM) in pediatric patients with Crohn’s disease (CD).  

Evidence Rating Level: 2 (Good)

In recent years, treatment goals for CD have shifted from symptom alleviation to resolution of intestinal inflammation, with the achievement of transmural healing (TH) being associated with improved long-term outcomes. In line with this, in recent years MRE has come to play an increasing role in defining disease extent and location. This prospective observational study therefore sought to investigate the longitudinal attainment of TH in a pediatric cohort and the comparative effectiveness of anti-TNF and IM therapy as maintenance therapy using a novel MRE index, the pediatric inflammatory Crohn’s disease magnetic resonance index (PICMI). 80 patients (median age at diagnosis, 13.5; 73% male) from a tertiary pediatric IBD referral centre with CD who had not received prior anti-TNF were enrolled. The primary outcome was at least mild improvement in PICMI-SB without alteration in therapy, with secondary outcomes being normalization on MRE at the 1-year follow-up. 77% (20/26) of patients receiving ADA and 44% (16/36) receiving IM (P = 0.01) achieved steroid-free clinical remission at 1 year without change in therapy. Based on MRE findings, transmural inflammation improved at least mildly in 54% of patients receiving ADA and 31% in patients receiving IM (P = 0.01). Normalization of MRE occurred in 29% of patients receiving ADA and 14% of patients receiving IM (P = 0.18). Overall, this study found that maintenance therapy with ADA in pediatric CD patients was associated with more frequent objective improvement per MRE findings than maintenance therapy with IM, but that MRE normalization remains infrequent regardless of treatment strategy. 

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