Infliximab and adalimumab were found to be similarly effective and safe in treating patients with Crohn’s disease in a recent study.
Using Medicare data from 2006 to 2010, researchers, including Meenakshi Bewtra, MD, MPH, PhD, assistant professor of medicine and epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, conducted a retrospective study of patients with Crohn’s disease (CD). All were new users of the anti-tumor necrosis factor (anti-TNF) drugs infliximab (n=1,459) or adalimumab (n=871); that is, they had not received anti-TNF drugs for 12 months before their first anti-TNF prescription in the Medicare data. Patients aged older than 85 years and those diagnosed with other indications for anti-TNF therapy were excluded from the study. Primary outcomes included steroid-free and surgery-free persistence on therapy, hospitalization for CD and surgery.
After 26 weeks of therapy, 49% of patients receiving infliximab maintained medication, compared with 47% of those assigned adalimumab (adjusted OR=0.98; 95% CI, 0.81-1.19). Extending follow-up to 52 weeks revealed similar rates of persistence for infliximab and adalimumab: 31% vs. 28%, respectively, (aOR=1.08; 95% CI, 0.86-1.37).
Fewer patients treated with infliximab required surgery than adalimumab patients, but this difference was not significant (5.5 vs. 6.9 surgeries per 100 person-years; aHR=0.79; 95% CI, 0.60-1.05). Likewise, hospitalization rates did not differ significantly between groups (11.8 vs. 15.4 hospitalizations per 100 person-years; aHR=0.88; 95% CI, 0.72-1.07). All outcome measures were tested for interaction by age (<65 vs. ≥65 years), and no evidence of interaction was observed except for the likelihood of surgery. Infliximab appeared to be protective in patients aged younger than 65 years compared with adalimumab (aOR=0.66; 95% CI, 0.47-0.93).
With no significant differences observed across three metrics of clinical effectiveness, the researchers concluded that the data “suggest comparable effectiveness of these medications as used in clinical practice.” Furthermore, these findings justify “allowing patients’ preferences to be a major factor when choosing between these two medications,” the researchers said.
Disclosure: See the study for a full list of relevant financial disclosures.