Role of Adalimumab in Treating Moderate to Severe Ulcerative Colitis

Efficacy and Positioning in Treatment Algorithm

The American Gastroenterological Association (AGA) classifies adalimumab as a "LOWER efficacy medication" compared to "HIGHER efficacy" options and "INTERMEDIATE efficacy" options 1, 3
In biologic-naïve patients, infliximab demonstrated superiority over adalimumab in network meta-analyses 4, 5
In head-to-head trials, vedolizumab showed significantly higher clinical remission rates compared to adalimumab in biologic-naïve patients 4, 6
Despite lower efficacy, adalimumab remains a viable option for patients who value the convenience of self-administered subcutaneous injections, particularly those with less severe disease 2, 4

Combining TNF antagonists, including adalimumab, with immunomodulators is suggested over TNF antagonist monotherapy or immunomodulator monotherapy 1
In patients with moderate-to-severe UC who are in corticosteroid-free clinical remission for at least 6 months on combination therapy of TNF antagonists and an immunomodulator, the AGA suggests against withdrawal of TNF antagonists 1
In patients previously exposed to anti-TNF agents, particularly those with primary non-response to infliximab, the AGA suggests using ustekinumab or tofacitinib rather than adalimumab or vedolizumab 7

Adalimumab may be less effective than other biologics but should not be overlooked for patients who prioritize the convenience of self-administration 4, 6
Drug concentrations were not optimized in clinical trials; efficacy of adalimumab may be comparable to other TNF antagonists when adequate drug concentrations are achieved 6