Comparative Effectiveness of Infliximab and Adalimumab in Crohn's Disease and Ulcerative Colitis.

Abstract

BACKGROUND:

The availability of monoclonal antibodies to tumor necrosis factor α has revolutionized management of Crohn's disease (CD) and ulcerative colitis. However, limited data exist regarding comparative effectiveness of these agents to inform clinical practice.

METHODS:

This study consisted of patients with CD or ulcerative colitis initiation either infliximab (IFX) or adalimumab (ADA) between 1998 and 2010. A validated likelihood of nonresponse classification score using frequency of narrative mentions of relevant symptoms in the electronic health record was applied to assess comparative effectiveness at 1 year. Inflammatory bowel disease-related surgery, hospitalization, and use of steroids were determined during this period.

RESULTS:

Our final cohort included 1060 new initiations of IFX (68% for CD) and 391 of ADA (79% for CD). In CD, the likelihood of nonresponse was higher in ADA than IFX (odds ratio, 1.62 and 95% CI, 1.21-2.17). Similar differences favoring efficacy of IFX were observed for the individual symptoms of diarrhea, pain, bleeding, and fatigue. However, there was no difference in inflammatory bowel disease-related surgery, hospitalizations, or prednisone use within 1 year after initiation of IFX or ADA in CD. There was no difference in narrative or codified outcomes between the 2 agents in ulcerative colitis.

CONCLUSIONS:

We identified a modestly higher likelihood of symptomatic nonresponse at 1 year for ADA compared with IFX in patients with CD. However, there were no differences in inflammatory bowel disease-related surgery or hospitalizations, suggesting these treatments are broadly comparable in effectiveness in routine clinical practice.

• Authors: Ashwin N Ananthakrishnan, Andrew Cagan, Tianxi Cai, Vivian S Gainer, Stanley Y Shaw, Guergana Savova, Susanne Churchill, Elizabeth W Karlson, Isaac Kohane, Katherine P Liao, Shawn N Murphy
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 22 Issue 4 Pg. 880-5 (Apr 2016) ISSN: 1536-4844 [Electronic] England
• PMID: 26933751 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Anti-Inflammatory Agents
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Colitis, Ulcerative (drug therapy)
• Crohn Disease (drug therapy)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infliximab (therapeutic use)
• Male
• Prognosis
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)