Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1302–1310 | Cite as

Comparative Effectiveness of Infliximab Versus Adalimumab in Patients with Biologic-Naïve Crohn’s Disease

  • Amine Benmassaoud
  • Talal Al-Taweel
  • Mark Solomon Sasson
  • Dasha Moza
  • Matthew Strohl
  • Uri Kopylov
  • Laurence Paradis-Surprenant
  • Mohanad Almaimani
  • Alain Bitton
  • Waqqas Afif
  • Peter L. Lakatos
  • Talat Bessissow
Original Article



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.


Infliximab Adalimumab Efficacy Crohn’s disease 


Author's contribution

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.

Supplementary material

10620_2017_4874_MOESM1_ESM.docx (120 kb)
Supplementary material 1 (DOCX 119 kb)


  1. 1.
    Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–333. (quiz 591).CrossRefPubMedGoogle Scholar
  2. 2.
    Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–1549.CrossRefPubMedGoogle Scholar
  3. 3.
    Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337:1029–1035.CrossRefPubMedGoogle Scholar
  4. 4.
    Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–885.CrossRefPubMedGoogle Scholar
  5. 5.
    Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–1395.CrossRefPubMedGoogle Scholar
  6. 6.
    Feagan BG, Panaccione R, Sandborn WJ, et al. Effects of adalimumab therapy on incidence of hospitalization and surgery in Crohn’s disease: results from the CHARM study. Gastroenterology. 2008;135:1493–1499.CrossRefPubMedGoogle Scholar
  7. 7.
    Sandborn WJ, Hanauer S, Loftus EV Jr, et al. An open-label study of the human anti-TNF monoclonal antibody adalimumab in subjects with prior loss of response or intolerance to infliximab for Crohn’s disease. Am J Gastroenterol. 2004;99:1984–1989.CrossRefPubMedGoogle Scholar
  8. 8.
    Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56:1232–1239.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rutgeerts P, Van Assche G, Sandborn WJ, et al. Adalimumab induces and maintains mucosal healing in patients with Crohn’s disease: data from the EXTEND trial. Gastroenterology. 2012;142:1102–1111. (e2).CrossRefPubMedGoogle Scholar
  10. 10.
    Colombel JF, Schwartz DA, Sandborn WJ, et al. Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Gut. 2009;58:940–948.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fine SN. Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Inflamm Bowel Dis. 2011;17:667–668.CrossRefPubMedGoogle Scholar
  12. 12.
    Matsumoto T, Motoya S, Watanabe K, et al. Adalimumab monotherapy and a combination with azathioprine for Crohn’s disease: a prospective, randomized trial. J Crohns Colitis. 2016;10:1259–1266.CrossRefPubMedGoogle Scholar
  13. 13.
    Doecke JD, Hartnell F, Bampton P, et al. Infliximab vs. adalimumab in Crohn’s disease: results from 327 patients in an Australian and New Zealand observational cohort study. Aliment Pharmacol Ther. 2017;45:542–552.CrossRefPubMedGoogle Scholar
  14. 14.
    Narula N, Kainz S, Petritsch W, et al. The efficacy and safety of either infliximab or adalimumab in 362 patients with anti-TNF-alpha naive Crohn’s disease. Aliment Pharmacol Ther. 2016;44:170–180.CrossRefPubMedGoogle Scholar
  15. 15.
    Singh S, Heien HC, Sangaralingham LR, et al. Comparative effectiveness and safety of anti-tumor necrosis factor agents in biologic-naive patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2016;14:1120–1129. (e6).CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Varma P, Paul E, Huang C, et al. A retrospective comparison of infliximab versus adalimumab as induction and maintenance therapy for Crohn disease. Intern Med J. 2016;46:798–804.CrossRefPubMedGoogle Scholar
  17. 17.
    Ma C, Huang V, Fedorak DK, et al. Crohn’s disease outpatients treated with adalimumab have an earlier secondary loss of response and requirement for dose escalation compared to infliximab: a real life cohort study. J Crohns Colitis. 2014;8:1454–1463.CrossRefPubMedGoogle Scholar
  18. 18.
    Cholapranee A, Hazlewood GS, Kaplan GG, et al. Systematic review with meta-analysis: comparative efficacy of biologics for induction and maintenance of mucosal healing in Crohn’s disease and ulcerative colitis controlled trials. Aliment Pharmacol Ther. 2017;45:1291–1302.CrossRefPubMedGoogle Scholar
  19. 19.
    Hazlewood GS, Rezaie A, Borman M, et al. Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn’s disease: a network meta-analysis. Gastroenterology. 2015;148:344–354. (e5; quiz e14-5).CrossRefPubMedGoogle Scholar
  20. 20.
    Romberg-Camps MJ, Dagnelie PC, Kester AD, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol. 2009;104:371–383.CrossRefPubMedGoogle Scholar
  21. 21.
    Veloso FT. Clinical predictors of Crohn’s disease course. Eur J Gastroenterol Hepatol. 2016;28:1122–1125.CrossRefPubMedGoogle Scholar
  22. 22.
    Kestens C, van Oijen MG, Mulder CL, et al. Adalimumab and infliximab are equally effective for Crohn’s disease in patients not previously treated with anti-tumor necrosis factor-alpha agents. Clin Gastroenterol Hepatol. 2013;11:826–831.CrossRefPubMedGoogle Scholar
  23. 23.
    Tursi A, Elisei W, Picchio M, et al. Effectiveness and safety of infliximab and adalimumab for ambulatory Crohn’s disease patients in primary gastroenterology centres. Eur J Intern Med. 2014;25:485–490.CrossRefPubMedGoogle Scholar
  24. 24.
    Kopylov U, Al-Taweel T, Yaghoobi M, et al. Adalimumab monotherapy versus combination therapy with immunomodulators in patients with Crohn’s disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8:1632–1641.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Amine Benmassaoud
    • 1
  • Talal Al-Taweel
    • 1
    • 2
  • Mark Solomon Sasson
    • 1
  • Dasha Moza
    • 1
  • Matthew Strohl
    • 1
  • Uri Kopylov
    • 1
    • 3
  • Laurence Paradis-Surprenant
    • 1
  • Mohanad Almaimani
    • 1
  • Alain Bitton
    • 1
  • Waqqas Afif
    • 1
  • Peter L. Lakatos
    • 1
    • 4
  • Talat Bessissow
    • 1
  1. 1.Division of Gastroenterology, Montreal General HospitalMcGill University Health CenterMontrealCanada
  2. 2.Haya Al-Habeeb Gastroenterology CenterMubarak Al-Kabeer HospitalJabriyaKuwait
  3. 3.Department of GastroenterologySheba Medical CentreTel-AvivIsrael
  4. 4.First Department of MedicineSemmelweis UniversityBudapestHungary

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