Please select the eligibility criteria that correspond to the clinical trial below.
Title: Adalimumab for the Treatment of Perianal Fistulas in Crohn's Disease More Effective Alone or Combined to Ciprofloxacin
Brief Summary: To assess whether a combination of ciprofloxacin and adalimumab is more effective than adalimumab alone for the treatment of perianal fistulas in Crohn's disease


Options:
A: Inclusion Criteria:

* Participant must have successfully enrolled in and completed Study M06-806 through Week 52.
* Participant must have been a responder at any time point during the M06-806 study (defined as having achieved at least a 15-point reduction in the Pediatric Crohn's Disease Activity Index (PCDAI) from Baseline).
* If female, participants who were sexually active and of child-bearing potential were to be practicing an approved method of birth control throughout the study and for 150 days after study drug administration. Examples of approved methods of birth control included the following:

  1. Condoms, sponge, foam, jellies, diaphragm or intrauterine device (IUD)
  2. Oral, parenteral or intravaginal contraceptives
  3. A vasectomized partner
* Participant of legal age, parent or legal guardian, as required, voluntarily signed and dated an Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved informed consent form, after the nature of the study was explained and the participant of legal age, participant's parent, or legal guardian, as required, had the opportunity to ask questions. Participants were to be included in all discussions, and if required, their signature on an assent form was to be obtained.
* Parent or legal guardian of participant who was not of legal age, as required, must have been willing to actively supervise storage and administration of study drug and to ensure that the time of each dose was accurately recorded in the participant's diary.
* Participants of legal age, must have been willing to actively store, administer, and accurately record study drug administration in the participant diary.
* Participant was judged to be in acceptable medical condition, as determined by the Principal Investigator based upon results of clinical and laboratory evaluations done throughout the preceding Crohn's disease study M06-806.

Exclusion Criteria:

* For any reason, the participant was considered by the Investigator to be an unsuitable candidate for continuing therapy in the M06-807 study.
* Participant had abnormal laboratory or other test results that in the opinion of the Investigator would make the participant unsuitable to participate in this study.
* History of cancer or lymphoproliferative disease other than a successfully and completely treated cutaneous squamous cell or basal cell carcinoma or carcinoma in-situ of the cervix.
* History of listeriosis, histoplasmosis, chronic or active hepatitis B infection, human immunodeficiency virus (HIV) infection, any immunodeficiency syndrome, central nervous system (CNS) demyelinating disease or active TB (receiving treatment or not receiving treatment). Ongoing severe infections such as sepsis and opportunistic infections were exclusionary.
* Participant with known, symptomatic obstructive strictures.
* Participant who was planning surgical bowel resection at any time point while enrolled in the study.
* Participant who had short bowel syndrome as determined by the Investigator.
* Participant who was receiving total parenteral nutrition (TPN).
* Participant who was unwilling to discontinue growth hormone prior to the first dose of open-label study drug at the Baseline visit of M06-807.
* Female participant who was pregnant or currently breastfeeding.
* Participant with a history of clinically significant drug or alcohol abuse in the last year.
* Participant with a poorly controlled medical condition such as: uncontrolled diabetes, recurrent infections, unstable ischemic heart disease, moderate to severe heart failure, recent cerebrovascular accidents or any other condition which, in the opinion of the Investigator or the Sponsor, would put the participant at risk by participation in the protocol.
* Participant with any prior exposure to Tysabri (natalizumab).
* Participant with a known hypersensitivity to the excipients of adalimumab as stated in the label.
* Participant with a previous history of dysplasia of the gastrointestinal tract.
B: Inclusion Criteria:

1. Subjects between the ages of 6 and 17, inclusive, prior to baseline dosing.
2. Subjects with a diagnosis of Crohn's disease for greater than 12 weeks prior to screening, confirmed by endoscopy or radiologic evaluation.
3. PCDAI \> 30 despite concurrent treatment with an oral corticosteroid, and/or azathioprine (AZA) or 6-mercaptopurine (6-MP) or methotrexate (MTX) as defined below:

   * Oral corticosteroid - Prednisone of ≥ 10 mg/day or equivalent, but not exceeding 40 mg, with a stable dose for at least two weeks prior to Baseline.
   * Azathioprine or 6-MP - AZA dose of ≥ 1.5 mg/kg/day or 6-MP dose of ≥ 1 mg/kg/day rounded to the nearest available tablet formulation, or a dose that is the highest tolerated for the subject, in the opinion of the investigator (for example due to leukopenia, elevated liver enzymes, nausea, etc.) for at least 8 weeks prior to Baseline with a stable dose for at least 4 weeks prior to Baseline.
   * MTX dose of ≥ 5 mg once weekly, either subcutaneously (SC), intramuscularly (IM), or orally for subjects whose body weight is ≥ 20 kg, or a dose that is the highest tolerated for the subject, in the opinion of the investigator (for example due to leukopenia, elevated liver enzymes, nausea, etc.) for at least 8 weeks prior to Baseline with a stable dose for at least 4 weeks prior to Baseline.
   * MTX dose of 0.2 mg/kg, up to 5 mg, once weekly, either SC, IM, or orally for subjects whose body weight is \< 20 kg, or a dose that is the highest tolerated for the subject, in the opinion of the investigator (for example due to leukopenia, elevated liver enzymes, nausea, etc.) for at least 8 weeks prior to Baseline with a stable dose for at least 4 weeks prior to Baseline.
   * Concurrent therapy will not be required for subjects who within the past 2 years in the opinion of the Investigator have not responded to or could not tolerate systemic corticosteroids, AZA, 6-MP, or MTX as defined below:

     * Corticosteroids:

       * Failed to successfully respond to corticosteroids, or
       * Medical complications and/or adverse events (AEs) from corticosteroids that in the judgment of their physician, precludes their use (e.g. psychosis, uncontrolled diabetes, osteoporosis, or osteonecrosis).
     * Azathioprine, 6-MP or MTX: -

       * Failed to successfully respond to these drugs or
       * Medical complications and/or AEs that in the judgment of their physician, precludes their use (e.g. allergic reaction, pancreatitis, elevated liver enzymes, hepatitis or leukopenia).
4. If female, subjects who were sexually active and were of child-bearing potential practicing an approved method of birth control throughout the study and for 150 days after study completion. Examples of approved methods of birth control included the following:

   * Condoms, sponge,foam,jellies,diaphragm, or intrauterine device (IUD)
   * Oral,parenteral, or intravaginal contraceptives for 12 weeks prior to adalimumab administration
   * A vasectomized partner.
5. Parent or legal guardian,as required,had voluntarily signed and dated an informed consent form (IFC), approved by an Institutional Review Board (IRB)/ Independent Ethics Committee (IEC).
6. Adequate cardiac, renal and hepatic function as determined by principal investigator and demonstrated by Screening laboratory evaluations, questionnaires, and physical examination results that are within normal limits.
7. Parent or legal guardian was willing to actively supervise storage and administration of study drug and to ensure that the time of each dose was accurately recorded in the subject's diary.
8. Subjects who had previously received infliximab, providing the subject had an initial response and then discontinued use due to a loss of response, or discontinued use due to intolerance.

Exclusion Criteria:

1. History of cancer or lymphoproliferative disease other than a successfully and completely treated cutaneous squamous cell or basal cell carcinoma or carcinoma-in-situ of the cervix.
2. History of listeria, histoplasmosis, chronic or active hepatitis B infection, human immunodeficiency virus (HIV), an immunodeficiency syndrome, central nervous system (CNS) demyelinating disease, or active tuberculosis (TB) (receiving treatment or not receiving treatment), severe infections such as sepsis and opportunistic infections.
3. Subject with infectious colitis, ulcerative colitis or indeterminate colitis as determined by the investigator and Abbott Medical Monitor.
4. Subject with symptomatic known obstructive strictures.
5. Subject who had surgical bowel resections within the past 24 weeks of the Baseline visit or planned any resection at any time point while enrolled in the study.
6. Subject with an ostomy or ileo-anal pouch. (Subjects with a previous ileo-rectal anastomosis were not excluded).
7. Subject who had short bowel syndrome as determined by the investigator.
8. Subject who was currently receiving total parenteral nutrition (TPN).
9. Females who were pregnant or were currently breast-feeding.
10. Subject who had received any investigational chemical agent in the past 30 days or 5 half-lives prior to Baseline (whichever was longer).
11. Subject who had received any investigational biological agent in the past 16 weeks or 5 half-lives prior to Baseline (whichever was longer).
12. Subject who has had systemic antibiotic, antiviral or antifungal treatment(s) within 3 weeks prior to Baseline for any non-Crohn's related infections.
13. Subject with a history of clinically significant drug or alcohol abuse in the last year.
14. Subjects with a poorly controlled medical condition such as: uncontrolled diabetes, recurrent infections, unstable ischemic heart disease, moderate to severe heart failure, recent cerebrovascular accidents and any other condition which, in the opinion of the investigator or the Sponsor, would put the subject at risk by participation in the protocol.
15. Subjects with positive C. difficile stool assay.
16. Subject who previously used infliximab within eight weeks of Baseline.
17. Subject who previously used infliximab and had not clinically responded at any time ("primary non-responder") unless subject experienced a treatment limiting reaction to infliximab.
18. Previous treatment with any other anti-TNF agent except infliximab.
19. Received previous treatment with adalimumab or previous participation in an adalimumab clinical study.
20. Screening laboratory and other analyses showing any of the following abnormal results:

    * Electrocardiogram (ECG) - with clinically significant abnormalities;
    * Aspartate transaminase (AST) or alanine transaminase (ALT) \>1.75 x the upper limit of the reference range;
    * Total bilirubin ≥ 3 mg/dL;
    * Serum creatinine \> 1.6 mg/dL;
21. Subjects on AZA, 6-MP, or MTX who had not been on these medications for at least 8 weeks prior to Baseline and on stable doses of these medications for at least 4 weeks prior to Baseline. Subjects who had been on AZA, 6-MP, or MTX who had discontinued these medications within 8 weeks of Baseline.
22. Subjects on aminosalicylates, or Crohn's-related antibiotics (fluoroquinolones such as ciprofloxacin or nitroimidazole derivatives such as metronidazole) that had not been on stable doses of these medications for at least 4 weeks prior to Baseline. In addition, subjects on aminosalicylates or Crohn's-related antibiotic treatments who had discontinued these medications within four weeks of Baseline.
23. Subjects on prednisone \> 40 mg/day (or equivalent) or subjects on \< 10 mg/day prednisone and subjects who were not on a stable dose for at least 2 weeks prior to Baseline. In addition, subjects who discontinued prednisone (or equivalent) within 2 weeks of Baseline.
24. Subjects on growth hormone that had not been on a stable dose for at least 12 weeks prior to Baseline. Subjects had to consent to remain on a stable dose through the duration of the study.
25. Subjects on budesonide \> 9 mg/day and subjects who were not on stable doses for at least 2 weeks prior to Baseline. In addition, subjects who discontinued budesonide within 2 weeks of Baseline.
26. Subjects who were currently taking both budesonide and prednisone (or equivalent).
27. Subjects who had undergone therapeutic enemas within two weeks prior to Baseline.
28. Subjects who had been on cyclosporine (intravenous \[IV\], oral), tacrolimus (any form), or mycophenolate mofetil within 28 days of Baseline.
29. Subjects who had been on Kineret® (anakinra) must discontinue use 2 days prior to Baseline.
30. Subjects with any prior exposure to Tysabri (natalizumab).
31. Subjects with known hypersensitivity to the excipients of adalimumab as stated in the label.
32. Subjects with a previous history of dysplasia of the gastrointestinal tract.
33. Subjects who weighed \< 17 kg at Screening.
34. Subject not in compliance with prior and concomitant medications.
C: Inclusion Criteria:

* proven Crohn's disease
* Single or multiple draining perianal fistulas

Exclusion Criteria:

* Abscesses
* Infliximab, cyclosporine, tacrolimus and antibiotics for Crohn's disease within past 3 months
* active viral infection
* significate cardiovascular dysfunction
* Pregnancy, Lactation
* Surgical bowel resection to be expected within 6 months
* Positive stool culture for enteric pathogens
* Total parental nutrition
D: Inclusion Criteria:

* Males and females between the ages of 18 and 75 who are diagnosed with mild to moderate Crohn's disease (defined by a CDAI \[Crohn's Disease Activity Index\] score of 220 and 450)
* Normal lab parameters
* Are willing to give informed consent
* Have previously used and either were intolerant to or lost response to infliximab

Exclusion Criteria:

* History of certain types of cancer
* Diagnosis of ulcerative colitis
* Pregnant female or breast feeding subjects
* Known obstructive strictures
* Surgical bowel resection in the past 6 months
* History of listeria, human immunodeficiency virus (HIV), central nervous system demyelinating disease or untreated TB (tuberculosis)
* History of poorly controlled medical conditions
* Specific doses and durations of Crohn's medications
* Subjects that have previously used infliximab and have never clinically responded unless primary non-response was due to a treatment limiting reaction to infliximab

Answer: C