The Safety and Efficacy of Adalimumab in Patients with Crohnʼs Disease: The Experience of a Single Tertiary Care Center
Notice bibliographique
Résumé
Purpose: Adalimumab, an anti-tumor necrosis factor human monoclonal antibody, is effective for the treatment of moderate to severe Crohn's disease. Adalimumab has been associated with adverse events including infections, allergic reactions, rashes, malgnancy, demyelinating disease and congestive heart failure. The purpose of this study is to determine the safety and efficacy of adalimumab in patients with Crohn's disease in clinical practice. Methods: A retrospective chart review was performed on patients treated with adalimumab for Crohn's disease at London Health Sciences Centre in London, Ontario, Canada. Data extracted and analyzed included patient and Crohn's disease demographics, remission and response rates with adalimumab and safety and tolerability of adalimumab. The Harvey-Bradshaw index (HBI) was used to determine Crohn's disease activity and response to therapy. Results: There were 149 patients with Crohn's disease treated with adalimumab. The mean patient age was 43 years; 64% were female and 33% were smokers. Disease location was ileocolic in 52%, ileal in 27% and colonic in 21%. The mean duration of Crohn's disease was 13 years. 52% had a prior bowel resection, 35% had fistulizing disease and 8% had a stoma. Patients on adalimumab were concomitantly on steroids in 18%, azathioprine in 39%, methotrexate in 34% and 5-aminosalicylates in 9%. The mean duration of therapy with adalimumab was 1.7 years (range 0.1-9.3 years), with 32% of patients discontinuing the medication after a mean duration of 1.1 years. Reasons for discontinuation included the lack of efficacy in 37%, loss of efficacy in 28%, intolerance in 26%, surgery in 7% and loss of insurance coverage in 2%. The mean HBI decreased from 9 to 6 after starting adalimumab. Patients on adalimumab achieved remission in 41% (HBI <5 and off steroids), had a response in 24% (HBI decrease of 3) and had no response in 35%. Of the patients that achieved remission, 78% maintained remission. Fistulas improved in 48% of patients on adalimumab. The most common adverse event while on adalimumab was infection in 30 (20%). Serious infections lead to death in one (<1%). Other adverse events encountered included rashes in 9 (6%), injection site reactions in seven (5%), myalgias and joint pain in three (2%), numbness in two (1%), allergic reactions in two (1%), headaches in two (1%), nausea and vomiting in two (1%), chest pain and shortness of breath in two (1%), cancer in one (<1%), demyelinating neuropathy in one (<1%) and interstitial pneumonitis in one (<1%). Conclusion: Adalimumab is an effective treatment for Crohn's disease. Adverse events can occur with its use. While most adverse events are mild, serious complications may less commonly occur necessitating close monitoring.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».