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No clinical superiority among anti-TNF agents for Crohn's disease
Anti-tumor necrosis factor agents infliximab, adalimumab and certolizumab pegol all had comparative efficacy for treatment of Crohn’s disease in a recent meta-analysis.
Akbar K. Waljee, MD, division of gastroenterology and hepatology, University of Michigan Health System, and colleagues performed traditional (TMA) and network meta-analyses (NMA) of infliximab (IFX), adalimumab (ADA) and certolizumab pegol (CZP) trials to evaluate efficacy for induction and maintenance of clinical response and remission in patients with Crohn’s disease (CD). Of the 506 studies drawn from PubMed, Medline and Embase databases, 10 placebo-controlled, randomized trials met eligibility criteria for the final analysis.
Akbar K. Waljee
The eligible pool of studies compared a single anti-TNF agent with placebo, and collectively included 1,771 subjects for induction and 1,690 subjects for maintenance. Data were extracted to evaluate induction and maintenance of remission and response.
Compared with placebo, TMA revealed that IFX had a 3.7-fold higher likelihood of inducing remission (95% CI, 0.87-15.8) and fourfold greater likelihood of inducing response (95% CI, 1.29-12.44). CZP was 1.22-fold more likely to induce remission (95% CI, 1-1.5) and 1.25-fold more likely to induce response (95% CI, 1.07-1.46). ADA was 2.94-fold more likely to induce remission (95% CI, 1.86-4.66) and 1.71-fold more likely to induce response (95% CI, 1.31-2.24).
NMA indicated trends of IFX superiority in remission induction to ADA (RR=1.52; 95% CrI, 0.2-17.46) and CZP (RR=4.29; 95% CrI, 0.65-46.09), but neither result was statistically significant. NMA also showed superiority of subcutaneous ADA to CZP in induction of remission (RR=2.93; 95%, CrI, 1.21-7.75).
For induction of response, NMA indicated superiority of IFX to ADA (RR=3.17; 95% CrI, 0.53-22.96) and CZP (RR=5.36; 95% CrI, 0.91-40.15), but these trends also were not statistically significant. For maintaining remission (ADA vs. IFX, RR=1.42; 95% CrI, 0.17-9.27; IFX vs. CZP, RR=1.23; 95% CrI, 0.26-13.14; ADA vs. CZP, RR=1.81; 95% CrI, 0.55-8.51) and response (ADA vs. CZP, RR=1.45; 95% CrI, 0.36-6.08; IFX data unavailable), NMA displayed no significant differences between agents.
Overall, the study showed no individual anti-TNF agent to be statistically superior for remission or maintenance of CD.
“In the absence of compelling data demonstrating variable efficacy, factors including safety, cost and patient preference should guide anti-TNF choice and sequencing,” the researchers concluded.
Disclosure: See the study for a full list of relevant financial disclosures.