From the Guidelines
For a patient with active Chronic Recurrent Multifocal Osteomyelitis (CRMO) who continues to have symptoms despite Adalimumab every 10 days, the next step would be to consider switching to an alternative medication, such as intravenous bisphosphonates (IVBP) or another tumor necrosis factor-alpha inhibitor (TNFi), as the current treatment is not providing sufficient relief. The patient's ongoing symptoms despite being on Adalimumab every 10 days indicate a need for re-evaluation of the treatment plan. According to the expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1, IVBP, such as pamidronate, or TNFi, such as infliximab or etanercept, can be considered as second-line treatments. Key considerations for the next steps include:
- Evaluating the patient's response to the current treatment and assessing for any potential side effects or complications 1
- Considering the use of IVBP, such as pamidronate, which has been shown to be effective in reducing pain and inflammation in patients with CNO 1
- Alternatively, switching to another TNFi, such as infliximab or etanercept, may be considered, as these medications have also been shown to be effective in treating CNO 1
- The patient's treatment plan should be individualized, taking into account their specific needs and circumstances, and should be regularly monitored and adjusted as necessary 1. It is essential to weigh the potential benefits and risks of each treatment option and to consider the patient's overall health and well-being when making decisions about their care. In terms of specific treatment regimens, the expert consensus recommendations suggest the following:
- Pamidronate can be administered as an intravenous infusion of 3 x 30 mg on 3 consecutive days, every 3 months 1
- Infliximab can be administered as an intravenous infusion of 3-5 mg/kg at 0,2, and 6 weeks, and then every 6-8 weeks 1
- Etanercept can be administered as a subcutaneous injection of 50 mg/week 1. Ultimately, the choice of treatment will depend on the individual patient's needs and circumstances, and should be made in consultation with a healthcare professional.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment of Active CRMO
- The provided studies do not directly address the treatment of active Chronic Recurrent Multifocal Osteomyelitis (CRMO) with Adalimumab every 10 days.
- However, study 2 discusses the treatment options for CRMO, mentioning that it is an autoinflammatory bone disorder, and variable defects in the TLR4/MAPK/inflammasome signaling cascade may result in an imbalance between pro- and anti-inflammatory cytokine expressions.
Adalimumab Treatment
- Study 3 compares the introduction of Adalimumab with methotrexate escalation in patients with psoriatic arthritis, finding that the addition of Adalimumab results in a higher proportion of patients reaching minimal disease activity.
- Study 4 investigates the use of Adalimumab added to methotrexate and intra-articular triamcinolone in early rheumatoid arthritis, finding improved remission rates, function, and quality of life.
- Study 5 examines the effectiveness of Adalimumab monotherapy versus Adalimumab with methotrexate for psoriasis, finding no evidence of a difference in effectiveness and persistence between the two treatments.
Next Steps for Active CRMO Treatment
- Given the lack of direct evidence for the treatment of active CRMO with Adalimumab every 10 days, it is unclear what the next step would be.
- However, based on the studies provided, it may be worth considering adjusting the Adalimumab dosage or adding other treatments, such as methotrexate, to the regimen, as seen in studies 3 and 4.
- Further research and consultation with a medical professional would be necessary to determine the best course of action for a patient with active CRMO.