Lower adalimumab trough levels are associated with higher bowel wall thickness in Crohn's disease

Bella Ungar*, Zohar Ben-Shatach, Limor Selinger, Alona Malik, Ahmad Albshesh, Shomron Ben-Horin, Rami Eliakim, Uri Kopylov, Dan Carter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In Crohn's disease, higher adalimumab trough levels and negative anti-adalimumab-antibodies associate with better clinical and endoscopic outcomes. Intestinal ultrasound has become a relevant non-invasive method to monitor treatment. However, data on the association between adalimumab levels and bowel wall thickness measured with ultrasound is limited. Objective: The purpose of this study was to examine the possible association between the sonographic transmural-thickness and adalimumab trough levels. Methods: This prospective observational cohort study was conducted at Sheba Medical Center in 2014–2018. Crohn's disease patients on adalimumab maintenance therapy with intestinal ultrasound performed within <30 days of trough level measurement were included. Associations between terminal ileum and colonic thickness, adalimumab levels and therapy retention were assessed. Results: Fifty events of ultrasound with concomitant adalimumab trough level measurements in 44 Crohn's disease patients were included. Patients with trough level <3 μg/ml had significantly higher bowel wall thickness, both for terminal ileum (p = 0.04) and colon (p = 0.02). Thirty-two patients continued adalimumab therapy over one year. The adalimumab retention rate was higher among those with terminal ileum thickness <4 mm (p = 0.03). Conclusion: Lower adalimumab trough levels were associated with higher bowel wall thickness indicating poorer therapy outcome. Transmural thickness measurement with ultrasound may be a useful target for guiding biologic therapy in Crohn's disease.

Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalUnited European Gastroenterology Journal
Issue number2
StatePublished - 1 Mar 2020


  • Crohn's disease
  • adalimumab
  • anti-tumor necrosis factor
  • biological therapy
  • biologics
  • intestinal ultrasonography
  • pharmacokinetics
  • transmural thickness


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