Biologic Therapy of Ulcerative Colitis: Adalimumab

  • Walter ReinischEmail author


Anti-TNF-α agents play a key role in the treatment of moderately to severely active ulcerative colitis, a chronic inflammatory disease of the large intestine which causes are still unknown. After infliximab, adalimumab became the second approved drug out of this class for use in ulcerative colitis. In the pivotal ULTRA studies the efficacy of adalimumab to induce and maintain remission was demonstrated and in an extension study the durability of its therapeutic benefit was shown. The real-life experience with adalimumab is in line with the observations from the randomized, placebo-controlled trials. Some post hoc evidence supports a preferential application of adalimumab in a more moderate disease setting, particularly in patients not being previously exposed to treatment with infliximab. However, we are supposed to obtain a more comprehensive picture of the therapeutic potential of adalimumab in ulcerative colitis once the results from the high-dose induction studies will become available. The following article summarizes the existing evidence on the efficacy of adalimumab in ulcerative colitis.


Ulcerative colitis Biologics Anti-TNF-α Adalimumab 


  1. 1.
    Solberg IC, Lygren I, Jahnsen J, Aadland E, Høie O, Cvancarova M, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009;44:431–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Murch SH, Lamkin VA, Savage MO, Walker-Smith JA, MacDonald TT. Serum concentrations of tumor necrosis factor alpha in childhood chronic inflammatory bowel disease. Gut. 1991;32:913–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Masuda H, Iwai S, Tanaka T, Hayakawa S. Expression of IL-8, TNF-alpha and IFN-gamma m-RNA in ulcerative colitis, particularly in patients with inactive phase. J Clin Lab Immunol. 1995;46:111–23.PubMedGoogle Scholar
  4. 4.
    Nielsen OH, Gionchetti P, Ainsworth M, Vainer B, Campieri M, Borregaard N, et al. Rectal dialysate and fecal concentrations of neutrophil gelatinase-associated lipocalin, interleukin-8, and tumor necrosis factor-alpha in ulcerative colitis. Am J Gastroenterol. 1999;94:2923–8.PubMedGoogle Scholar
  5. 5.
    Breese EJ, Michie CA, Nicholls SW, Murch SH, Williams CB, Domizio P, et al. Tumor necrosis factor alpha-producing cells in the intestinal mucosa of children with inflammatory bowel disease. Gastroenterology. 1994;106:1455–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Sands BE, Kaplan GG. The role of TNF alpha in ulcerative colitis. J Clin Pharmacol. 2007;47:930–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Peyrin-Biroulet L, Laclotte C, Roblin X, Bigard MA. Adalimumab induction therapy for ulcerative colitis with intolerance or lost response to infliximab: an open-label study. World J Gastroenterol. 2007;13:2328–32.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Oussalah A, Laclotte C, Chevaux JB, Bensenane M, Babouri A, Serre AA, et al. Long-term outcome of adalimumab therapy for ulcerative colitis with intolerance or lost response to infliximab: a single-centre experience. Aliment Pharmacol Ther. 2008 Oct 15;28:966–72.Google Scholar
  9. 9.
    Afif W, Leighton JA, Hanauer SB, Loftus Jr EV, Faubion WA, Pardi DS, et al. Open-label study of adalimumab in patients with ulcerative colitis including those with prior loss of response or intolerance to infliximab. Inflamm Bowel Dis. 2009;15:1302–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Barreiro-de Acosta M, Lorenzo A, Dominguez-Munoz JE. Adalimumab in ulcerative colitis: two cases of mucosal healing and clinical response at two years. World J Gastroenterol. 2009;15:3814–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Gies N, Kroeker KI, Wong K, Fedorak RN. Treatment of ulcerative colitis with adalimumab or infliximab: long-term follow-up of a single-centre cohort. Aliment Pharmacol Ther. 2010;32:522–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Taxonera C, Estellés J, Fernández-Blanco I, Merino O, Marín-Jiménez I, Barreiro-de Acosta M, et al. Adalimumab induction and maintenance therapy for patients with ulcerative colitis previously treated with infliximab. Aliment Pharmacol Ther. 2011;33:340–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Reinisch W, Sandborn WJ, Hommes DW, D’Haens G, Hanauer S, Schreiber S, et al. Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011;60:780–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Sandborn WJ, van Assche G, Reinisch W, Colombel JF, D’Haens G, Wolf DC, et al. Adalimumab induces and maintains clinical remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2012;142:257–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Reinisch W, Sandborn WJ, Panaccione R, Huang B, Pollack PF, Lazar A, et al. 52-week efficacy of adalimumab in patients with moderately to severely active ulcerative colitis who failed corticosteroids and/or immunosuppressants. Inflamm Bowel Dis. 2013;19:1700–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Sandborn WJ, Colombel JF, D’Haens G, Van Assche G, Wolf D, Kron M, et al. One-year maintenance outcomes among patients with moderately-to-severely active ulcerative colitis who responded to induction therapy with adalimumab: subgroup analyses from ULTRA 2. Aliment Pharmacol Ther. 2013;37:204–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Feagan BG, Sandborn WJ, Lazar A, Thakkar RB, Huang B, Reilly N, et al. Adalimumab therapy is associated with reduced risk of hospitalization in patients with ulcerative colitis. Gastroenterology. 2014;146:110–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Suzuki Y, Motoya S, Hanai H, Matsumoto T, Hibi T, Robinson AM, et al. Efficacy and safety of adalimumab in Japanese patients with moderately to severely active ulcerative colitis. J Gastroenterol. 2014;49:283–94.CrossRefPubMedGoogle Scholar
  19. 19.
    Colombel JF, Sandborn WJ, Ghosh S, Wolf DC, Panaccione R, Feagan B, et al. Four-year maintenance treatment with adalimumab in patients with moderately to severely active ulcerative colitis: Data from ULTRA 1, 2, and 3. Am J Gastroenterol. 2014;109:1771–80.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Danese S, Fiorino G, Peyrin-Biroulet L, et al. Biological agents for moderately to severely active ulcerative colitis: a systematic review and network meta-analysis. Ann Intern Med. 2014;160:704–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Baert F, Vande Casteele N, Tops S, et al. Prior response to infliximab and early serum drug concentrations predict effects of adalimumab in ulcerative colitis. Aliment Pharmacol Ther. 2014;40:1324–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Italian Group for the Study of Inflammatory Bowel Disease, Armuzzi A, Biancone L, Daperno M, et al. Adalimumab in active ulcerative colitis: a “real-life” observational study. Dig Liver Dis. 2013;45:738-43.Google Scholar
  23. 23.
    Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology. 2015;148:1035–58.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of MedicineMcMaster UniversityHamiltonCanada

Personalised recommendations