title: Adalimumab and infliximab are equally effective for Crohn's disease in patients not previously treated with anti-tumor necrosis factor-α agents.
abstract: OBJECTIVE
  Infliximab (IFX) and adalimumab (ADA) are thought to have equal efficacy for the treatment of Crohn's disease (CD), although no direct comparison has been performed. We compared the effectiveness and safety of IFX and ADA in carefully matched cohorts.
  
  
  METHODS
  We performed a retrospective cohort study of 200 patients with CD (100 treated with IFX and 100 treated with ADA, starting in 2006 or later) who had not received anti-tumor necrosis factor α agents previously; the patients were identified from databases of 6 hospitals in The Netherlands. The groups were matched carefully for indication, duration of disease, age, and Montreal classification. The primary end point was the steroid-free clinical response, defined by a combination of multiple clinical parameters, after 1 year.
  
  
  RESULTS
  Of the total patient population, 63.5% and 45% had a clinical response after 1 and 2 years, respectively. There were no significant differences between treatment groups: at 1 and 2 years, 62% and 41% of those receiving ADA vs 65% and 49% of those receiving IFX had responses, respectively. Kaplan-Meier curves showed identical decreases in response rates over time. Combining IFX or ADA with immunomodulator therapy was associated with a higher clinical response than monotherapy, although this was only significant among patients who received IFX (P = .03). There were no differences in numbers of side effects or opportunistic infections.
  
  
  CONCLUSIONS
  The effectiveness of ADA or IFX treatment in anti-tumor necrosis factor α-naive patients with CD is comparable after 1 and 2 years of follow-up evaluation. The efficacies of IFX and ADA each seem to increase when given with immunomodulator therapy, although only significantly for IFX.
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors: Christine
authors: C
authors: Kestens
authors: Martijn G H
authors: MG
authors: van Oijen
authors: Charlotte L J
authors: CL
authors: Mulder
authors: Ad A
authors: AA
authors: van Bodegraven
authors: Gerard
authors: G
authors: Dijkstra
authors: Dirk
authors: D
authors: de Jong
authors: Cyriel
authors: C
authors: Ponsioen
authors: Bas A C
authors: BA
authors: van Tuyl
authors: Peter D
authors: PD
authors: Siersema
authors: Herma H
authors: HH
authors: Fidder
authors: Bas
authors: B
authors: Oldenburg
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D000069285:Infliximab; D000068879:Adalimumab