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Adalimumab, infliximab similarly effective in Crohn’s disease patients naive to prior anti-TNF-a therapy
Patients with Crohn’s disease treated with adalimumab and infliximab who had not received previous anti-tumor necrosis factor-alpha therapy experienced similar outcomes in a recent study.
In a retrospective matched cohort study, researchers evaluated 200 patients with Crohn’s disease, including 100 treated with infliximab (IFX) and 100 treated with adalimumab (ADA). Patients were collected from the databases of six hospitals in the Netherlands, were anti-tumor necrosis factor-alpha-naive upon treatment initiation, and had been followed up for at least 1 year.
Steroid-free clinical response was observed in 63.5% of all cases at 1 year and 45% at 2 years. There was no significant difference in response rates between groups; 62% vs. 65% at 1 year and 41% vs. 49% at 2 years in the ADA and IFX groups, respectively. Rates of discontinuation, hospitalization or steroid use did not differ significantly between treatments.
One-third of ADA patients and two-thirds of the IFX group received immunomodulators, for a median duration of 18 months. Response rates at 2 years were 45% among immunomodulator users and 39% among nonusers in the ADA group (P=.63) and 59% and 25%, respectively, in the IFX group (P=.006).
Fifty-seven adverse events occurred, with similar prevalence between groups. Common events included infusion/injection reactions, which occurred in 18 IFX recipients and 16 ADA recipients; cutaneous manifestations in four of the IFX group and five of the ADA group, and muscle/joint issues in five cases in each group. Opportunistic infections occurred in 8% of ADA patients and 9% of the IFX group, with one severe case each for ADA (tuberculosis) and IFX patients (bacterial meningitis).
“IFX or ADA treatment is comparable after 1 and 2 years of follow-up evaluation with regard to response rates, side effects and opportunistic infections,” the researchers concluded. “Both IFX and ADA seem to be more effective when comedication is administered, although not statistically significantly so in the case of ADA.”
Disclosure: See the study for a full list of relevant disclosures.