Comparative Effectiveness of Infliximab Versus Adalimumab in Patients with Biologic-Naïve Crohn’s Disease
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Direct head-to-head studies comparing the long-term outcomes of infliximab (IFX) to adalimumab (ADA) in Crohn’s disease (CD) are sparse.
We compared the short-term and long-term efficacy and safety of IFX and ADA in CD.
We performed a single-center retrospective study including biologic-naïve adult patients with CD who were started on IFX or ADA at the McGill University Health Center. The primary end points were clinical response and remission at 12 months. Secondary end points included corticosteroid-free remission at 12 months, durable remission, and treatment failure with need for steroids, hospitalization or surgery. Safety was also assessed.
Two hundred and twenty patients were included (143 IFX, 77 ADA). Patients on IFX had a higher prevalence of fistulizing or perianal disease and corticosteroid treatment at baseline. Rates of clinical remission and corticosteroid-free remission at 12 months were similar between both groups: 63.8 versus 76.3% (p = 0.139) and 54.1 versus 44.7% (p = 0.354), respectively, for IFX and ADA. Combination therapy led to significantly higher remission rates at 12 months compared to monotherapy for patients on IFX (81.2 vs. 52.1%, p = 0.008), but not for those on ADA. Higher rates of adverse events were reported with IFX compared to ADA (p = 0.006).
Our real-life experience in biologic-naïve CD patients demonstrated that patients started on IFX were more likely to have a harder-to-treat phenotype. Despite that, efficacy end points were similar between both groups. Clinical remission was higher in patients with combination therapy for IFX, but not for those on ADA. This warrants further investigation.
KeywordsInfliximab Adalimumab Efficacy Crohn’s disease
AB and TAT collected the data, analyzed the data, interpreted the data, and wrote the paper; MS, DM, MS, LPS, MA collected the data; AB, WA, UK critically revised the manuscript; PL analyzed the data, interpreted the data, and critically revised the manuscript; TB conceived and designed the research, analyzed the data, interpreted the data, and critically revised the manuscript. All authors approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
Amine Benmassaoud, Mark Sasson, Dasha Moza, Matthew Strohl, Laurence Paradis-Surprenant, Mohanad Almaimani have no conflicts of interest to declare. Talal Al-Taweel has served as a speaker, a consultant, and an advisory board member for AbbVie, Janssen, and Takeda. Uri Kopylov has served as a speaker and/or consultant for Janssen, Takeda, AbbVie, and CTS and has received research funding from Takeda and Janssen. Waqqas Afif has served as a speaker and/or advisory board for AbbVie, Janssen, Takeda, Merck, Pfizer, Ferring, Shire, and received research grants from AbbVie, Theradiag, and Prometheus. Peter Lakatos has served as a speaker and/or advisory board member for AbbVie, EGIS, Falk Pharma GmbH, Ferring, Genetech, Janssen, Kyowa Hakko Kirin Pharma, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka Pharma, Pharmacosmos, Pfizer, Roche, Shire, and Takeda and has received unrestricted research funding from AbbVie, MSD, and Pfizer. Talat Bessissow has served as a speaker, a consultant, and an advisory board member for Janssen, AbbVie, Takeda, Pfizer, Ferring, Pendopharm, Shire and has received research funding from AbbVie and Janssen.