Maarten Cozijnsen

102 At adalimumab commencement, 3 patients were in clinical remission. One patient had switched to adalimumab treatment because of infliximab-related vasculitis, the second had recently undergone an ileocecal resection, and in the third luminal activity was seen with high levels of ATI, despite mild symptoms and normal markers of inflammation. During follow-up remission was reached in 34 patients (64%) after a median of 3.3 months (IQR 1.7-8.3). Ten of those subsequently lost remission after a median of 4.7 months (IQR 2.7-10.3). Survival analysis demonstrates a 50% maintained remission rate at 24 months (Figure 1). Eleven out of the remaining 19 patients did not reach remission but did reach clinical response (Table 2).                          Figure 1. Duration of remission Cumulative hazard curve displaying the duration of remission, i.e. the time from induction of remission untill a first relapse, for those patients reaching remission during follow-up. After 6 months 70% of these patients maintained remission and 50% after 24 months. Adalimumab failure During the observation period 18 patients (34%) failed adalimumab therapy, eleven of whom discontinued therapy and seven failed because CD related surgery was performed. None of the patients discontinued therapy because of remission. Six patients had first reached remission but lost response (n=4) or suffered adverse effects (n=2), another 6 patients had reached clinical response but lost response (n=6), and the remaining 6 patients did not respond to adalimumab and failed due to non-response (n=4), adverse effects (n=1) or lost response (n=1) – the latter patient had mild disease activity at baseline, infliximab was stopped because of an allergic reaction, and mild activity was retained with adalimumab for 12 months until a relapse occurred.