Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study. Issue 4 (19th December 2016)

• Record Type: Journal Article
• Authors: Doecke, J. D.; Hartnell, F.; Bampton, P.; Bell, S.; Mahy, G.; Grover, Z.; Lewindon, P.; Jones, L. V.; Sewell, K.; Krishnaprasad, K.; Prosser, R.; Marr, D.; Fischer, J.; R Thomas, G.; Tehan, J. V.; Ding, N. S.; Cooke, S. E.; Moss, K.; Sechi, A.; De Cruz, P.; Grafton, R.; Connor, S. J.; Lawrance, I. C.; Gearry, R. B.; Andrews, J. M.; Radford‐Smith, G. L.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 45:Issue 4(2017)
• Page Start: 542
• Page End: 552
• Publication Date: 2016-12-19
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13880
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Maintenance anti‐tumour necrosis factor‐α (anti‐TNFα) treatment for Crohn's disease is the standard of care for patients with an inadequate response to corticosteroids and immunomodulators. Aim: To compare the efficacy and safety of infliximab and adalimumab in clinical practice and assess the value of concomitant immunomodulator therapy. Methods: We performed an observational cohort study in consecutive patients with Crohn's disease qualifying for anti‐TNF α treatment in Australia and New Zealand between 2007 and 2011. Demographic and clinical data were prospectively recorded to identify independent factors associated with induction and maintenance of response to infliximab or adalimumab, or to either anti‐TNF α therapy. Results: Three hundred and twenty‐seven patients (183 infliximab, 144 adalimumab) successfully applied for treatment. Eighty‐nine percent responded in all groups and median maintenance of response was similar for the two agents. Concomitant immunomodulator with infliximab, but not adalimumab, demonstrated a significantly longer response overall ( P = 0.002), and significantly fewer disease and treatment‐related complications ( P = 0.017). Corticosteroids at baseline, and/or in the preceding 12 months, were associated with a 9–13 times greater risk of disease flare during maintenance treatment as compared to no corticosteroids ( P < 0.0001). Maintenance of response was similar in the anti‐TNF naïve and anti‐TNF experienced subgroups. Conclusions: In this large, real‐life study, we demonstrate infliximab and adalimumab to have similar response characteristics. However, infliximab requires concomitant immunomodulator to achieve optimal maintenance of response comparable to adalimumab monotherapy. The results of this study will assist clinicians in further optimising patient care in their day‐to‐day clinical practice. Abstract : Linked Content This article is linked to Barreiro‐de Acosta and Gisbert and Radford and Hartnell et al papers. To view these articles visithttps://doi.org/10.1111/apt.13929 andhttps://doi.org/10.1111/apt.13968 .