Reduce Risk for Crohn's Disease Patients

Exclusion Criteria

• •1. Patients with wPCDAI\<42,5 at initial diagnosis, except if CRP\>2 times upper limit
• •2. No induction therapy with steroids or enteral nutrition
• •3. Previous therapy with any IBD (inflammatory bowel desease) -related medications other than induction therapy as detailed in this protocol (except 5-ASA).
• •4. Pregnancy or refusal to use contraceptives during the study period in pubertal patients (both boys and girls) unless absolute abstinence (no sexual activity) is confirmed at each study visit. Positive pregnancy testing throughout the study will trigger prompt withdrawal of the patient from the study.
• •5. Lactating mothers
• •6. Children with perianal fistulising disease who require surgical therapy (drainage, seton placement)
• •7. Patients homozygous for Thiopurine methyl transferase or those with Thiopurine methyl transferase activity \<6 nmol/h/ml erythrocytes or \<9nmol 6MTG (6 methylthioguanine/g Hb/h), unless they qualify as high risk patients
• •8. Evidence of un-drained and un-controlled abscess/phlegmon
• •9. Contraindication to any drugs used in the trial (including intolerance/hypersensitivity or allergy to either study drug (thiopurines, methotrexate or adalimumab))
• •10. Current or previous malignancy
• •11. Serious comorbidities (such as renal insufficiency, hepatitis, respiratory insufficiency) interfering with drug therapy or interpretation of outcome parameters or will make it unlikely that the patients will finish the trial.
• •12. Infection with mycobacterium tuberculosis
• •13. Moderate to severe heart failure (NYHA classe III/IV)
• •14. Oral anticoagulant therapy, anti-malaria therapy
• •15. Live vaccines exposure (including yellow fever) less than 3 weeks prior inclusion