title: Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study.
abstract: 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.
  
  
  
  To compare the efficacy and safety of infliximab and adalimumab in clinical practice and assess the value of concomitant immunomodulator therapy.
  
  
  
  We performed an observational cohort study in consecutive patients with Crohn's disease qualifying for anti-TNFα 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-TNFα therapy.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Parkville, Vic., Australia.|Brisbane, Qld, Australia.
authors.forename: J D
authors.initials: JD
authors.lastname: Doecke
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Hartnell
authors.affiliation: Bedford Park, SA, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Bampton
authors.affiliation: Melbourne, Vic., Australia.
authors.forename: S
authors.initials: S
authors.lastname: Bell
authors.affiliation: Townsville, Qld, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Mahy
authors.affiliation: Perth, WA, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Grover
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Lewindon
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: L V
authors.initials: LV
authors.lastname: Jones
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Sewell
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Krishnaprasad
authors.affiliation: Bedford Park, SA, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Prosser
authors.affiliation: Murdoch, WA, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Marr
authors.affiliation: Christchurch, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Fischer
authors.affiliation: Christchurch, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: R Thomas
authors.affiliation: Melbourne, Vic., Australia.
authors.forename: J V
authors.initials: JV
authors.lastname: Tehan
authors.affiliation: Melbourne, Vic., Australia.
authors.forename: N S
authors.identifier: 0000-0002-6232-1948
authors.initials: NS
authors.lastname: Ding
authors.affiliation: Townsville, Qld, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Cooke
authors.affiliation: Bedford Park, SA, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Moss
authors.affiliation: Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Sechi
authors.affiliation: Melbourne, Vic., Australia.
authors.forename: P
authors.initials: P
authors.lastname: De Cruz
authors.affiliation: Adelaide, SA, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Grafton
authors.affiliation: Sydney, NSW, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Connor
authors.affiliation: Murdoch, WA, Australia.
authors.forename: I C
authors.initials: IC
authors.lastname: Lawrance
authors.affiliation: Christchurch, New Zealand.
authors.forename: R B
authors.initials: RB
authors.lastname: Gearry
authors.affiliation: Adelaide, SA, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Andrews
authors.affiliation: Brisbane, Qld, Australia.
authors.forename: G L
authors.initials: GL
authors.lastname: Radford-Smith
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D000069285:Infliximab; D000068879:Adalimumab