A retrospective comparison of infliximab versus adalimumab as induction and maintenance therapy for Crohn disease

BackgroundIn Australia, infliximab (IFX) and adalimumab (ADA) are available for the treatment of moderate-severe Crohn disease (CD) refractory to conventional therapies, with minimal local data comparing their efficacy. AimThe aim of this study was to compare clinical and biochemical outcomes at 3 and 12months between patients receiving induction and maintenance therapy with IFX versus ADA. MethodsRetrospective single-centre audit of all patients commenced on IFX or ADA as their first anti-tumour necrosis factor agent between July 2007 and May 2012. Clinical and biochemical parameters were compared pre-commencement, 3 and 12months post-commencement. ResultsA total of 81 patients was included in the study; 63 IFX-treated and 18 ADA-treated. Significant Crohn disease activity index (CDAI) reductions were noted within both groups at 3months (P<0.001) and 12months (P<0.001). Similarly, significant reductions were noted in steroid doses within groups at 3months (P<0.05) and 12months (P<0.05), with notable reductions in C-reactive protein (CRP) at 3months within groups (P<0.05). Adverse events occurred in 14.3% of IFX and 11.1% of ADA patients. Comparing IFX with ADA, no difference was shown between groups in CDAI reductions at 3months (P=0.94) and 12months (P=0.95), steroid dosing at 3months (P=0.23) and 12months (P=0.81), and CRP reduction at 3months (P=0.33) and 12months (P=0.62). Fistula-related admissions were significantly reduced in IFX patients (100% reduction post-IFX vs 66.7% post-ADA) (P=0.01). ConclusionClinical and biochemical outcomes were similar in patients treated with IFX or ADA as induction and maintenance therapy for CD. However, significant reductions were noted in admissions relating to fistulising disease in IFX patients.