SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
11/17/04
Use of adalimumab in infliximab-allergic patients
Summary
Background - Infliximab (Flix) is a chimeric (mouse/human) monoclonal antibody against tumor necrosis factor, alpha (TNF alpha). Treatment with Flix has often been highly effective in Crohn's disease and rheumatoid arthritis. However, some Flix treated patients experience allergic reactions, possibly due to anti-chimeric antibodies formed by recipients during Flix treatment.
Findings - Adalimumab (Adal) is a fully humanized anti-TNF alpha monoclonal antibody more recently available for clinical use. Youdim et al of the UCLA in Los Angeles, CA carried out a pilot trial of Adal in 7 Crohn's disease patients who had previously experienced immediate or delayed hypersensitivity reactions to Flix requiring stoppage of Flix therapy. All tolerated Adal treatment well with only local injection site reactions but no serious systemic adverse effects. One of the 7 patients who had previously received IV Ig (pooled) therapy did manifest a rash after receiving each dose of Adal. Patients with active Crohn's disease who had previously improved with Flix treatment subsequently manifested similar improvement with Adal therapy.
Reference
Inflamm Bowel Dis 2004;10:333-8
Editor's Comments
The findings described above are encouraging in light of the fact that systemic allergic-type reactions to Flix are not rare. It remains to be seen whether patients treated repeatedly with Adal will form anti-human antibodies (sometimes called HAHA) that may lead to more rapid clearing of Adal in the recipient and/or adverse allergic-type reactions. It is also not yet clarified whether some of the non-allergic types of adverse effects seen occasionally in Flix-treated patients (reactivation of Tb infection, cytopenias, cardiac effects) will also be seen in Adal-treated patients.
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