Issue 24

Clinical Question

Does adalimumab (ADA) have a therapeutic benefit on bone growth in patients with Crohn’s disease (CD)?

Editor’s Bottom Line

Adalimumab treatment improves bone growth parameters in CD and osteoblast cell culture experiments suggest a direct mechanism on the osteoblasts themselves.

Editorial Note

These results are similar to those seen for infliximab, that is, treating CD improves bone health. For both drugs, the role of controlling disease activity vs. a direct effect on bone itself remains to be further elucidated.

Reference

Veerappan SG, Healy M, Walsh BJ, et al. Adalimumab therapy has a beneficial effect on bone metabolism in patients with Crohn’s disease. Dig Dis Sci. 2015;60:2119–29. https://www.ncbi.nlm.nih.gov/pubmed/25732718

Synopsis – Study

CD patients with active disease were started on ADA at standard induction and maintenance doses. Sera was collected at baseline, 1, 3, and 6 months. Control subjects, age- and sex-matched non-IBD individuals, provided sera once. At baseline in the CD cohort (n=20), 4 had osteoporosis and 10 had osteopenia while in the control group (n=20), 2 had osteoporosis and 11 had osteopenia on bone mineral density scans.

Inter-group comparison of CD patients, before and after ADA therapy, demonstrated significant increase in bone formation markers (P<0.05) and decrease in bone resorption markers, likely important to new bone formation.

Intra-group comparison of CD vs. control patients was carried out in osteoblast cell culture experiments. Treatment of CD patients with ADA reduced osteoblast viability and function to control levels, likely important to new bone formation.

Details

Study Design: Observational, case-control study
Funding: None reported.
Allocation: N/A
Setting: Dublin, Ireland
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.