Adalimumab in ulcerative colitis - efficacy, safety and optimization in the era of treat-to target.

INTRODUCTION: Active ulcerative colitis is associated with significant morbidity and impairment to quality of life. Adalimumab is a welcome addition to the therapeutic armamentarium for clinicians treating patients with moderate-severe ulcerative colitis refractory to conventional therapies, an indication with few prior treatment options. It offers the convenience of self-injection and is most appropriate for outpatients with moderate disease activity. Areas covered: This review briefly summarizes data from well-designed clinical trials and observational real-life studies that demonstrate the safety and efficacy of adalimumab in UC. Particular attention is paid to newer studies, including those with objective treatment endpoints and pharmacokinetic outcomes that incorporate a treat to target approach in inflammatory bowel disease. Expert opinion: Adalimumab is effective for the induction and maintenance of remission in patients with moderate-severe ulcerative colitis refractory to conventional therapies. At currently approved doses, it is most suitable for use in outpatients with moderate disease activity; higher doses may be required for patients with more severe disease. The convenience of self-injection will make it popular for remote patients and it may be an appropriate option in patients in whom monotherapy, rather than combination therapy with an immunomodulator, is preferred.