Infliximab and adalimumab are drugs used when IBD does not respond to initial treatment. Both drugs are antibodies which block the action of tumour necrosis factor alpha (a key inflammation-causing protein in IBD). Lots of studies show the short term effect of these drugs but there is not much information on their long term use. This study from three hospitals in Israel looked back at the hospital records of children receiving either drug since 1999 and studied response to treatment.
102 children completed either the standard induction regime of infliximab (84) or adalimumab (18). Symptoms improved in 91 children. This response was sustained for a minimum of six months in 86 children. Studying children for many years in this type of study is often difficult as patients move to different hospitals for treatment as adults. This study was no exception. The average length of time each child was studied for was 15 months, and sadly, at 5 years data was only available for 8 patients. Despite this limitation the authors predicted the chance of children having a sustained response to treatment at different time points. At 2 years approximately 75% of patients would still have response to infliximab/adalimumab but at 5 years this may fall to around 55%.
Overall 17 patients experienced unpleasant side effects. Most (15) of these were allergic drug reactions at the time of treatment. There were no cases of cancer. Not surprisingly, children that responded to treatment had better weight gain than children that did not respond, however improvements in height were limited.
These results are similar to studies in adults which show that although effective in the short term, these drugs seem to lose effect with time. Disappointingly, it seems that nearly 50% of people receiving infliximab or adalimumab for 5 years see a loss of response and a return of clinical symptoms.
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