Adalimumab versus Infliximab in treating post-operative recurrence of Crohn’s disease: a national cohort study

Abstract

Aim: Perform a comparison between adalimumab (ADA) and infliximab (IFX) in treating post-operative recurrence of Crohn's disease (a comparative analysis of efficacy and safety).Methods: From the 267 patients treated with adalimumab or infliximab between January 2005 and June 2014 in Romania, 44 received anti-TNF (tumor necrosis factor) therapy for prevention of post-operative recurrence. A comparison between patients treated with IFX and ADA was made with the Chi-square and t-student test, with the aid of the statistical program Mini Tab 17.Results: Twenty-one patients received IFX and 23 ADA. This included 49% males (22/44), with a mean age of 41 years, mean disease duration of 6 years, and 84.1% had previously received azathioprine. The IFX group is comparable with the ADA group regarding most of the parameters, except for therapy duration. Mean duration of therapy was 33 months. The rate of complete response was comparable between the two groups: 67% in the IFX group vs. 78.3% in the ADA group, the same as the rate of reresection, 19.1% vs. 4.4% and the rate of endoscopic recurrence, 29 vs. 33% at 12 months. Risk factors for postoperative recurrence (POR) (male sex, younger age, ileocolonic location, stricturing or penetrating behaviour) were studied, only ileocolonic location was found to be associated with Crohn's disease recurrence in patients treated with ADA.Conclusions: Overall infliximab and aalimumab are equally efficient in patients with resected Crohn's disease (CD) with a complete response of 72.7%, a rate of re-resection of 11.4% and a rate of endoscopic recurrence of 35%. Ileocolonic location might be a predictive factor for loss of response to adalimumab in resected Crohn's disease patients.

Rate and risk factors of postoperative endoscopic recurrence of moderate- to high-risk Crohn's disease patients - A real-world experience from a Middle Eastern cohort

“…The rate of response was comparable between the two groups: 67% in the infliximab group versus 78.3% in the adalimumab group—the same as the rate of re-resection (repeated surgery), 19.1% versus 4.4%, and the rate of endoscopic recurrence, 29% versus 33% at 12 months. [ 26 ] In the current study; approximately one-third of our patient population were not on any pharmacological prophylaxis within the appropriate time post-surgery (within 12 weeks). Of the patient population studied, 76.2% did not have endoscopic POR, 41.9% were on biological (infliximab or adalimumab), and 34.3% were on non-biological therapy, mainly azathioprine.…”

“…Further, while 23.8% did have endoscopic POR, approximately 15% of them were on biological therapies similar to that reported in international literature. [ 8 23 26 ] Therefore, it may be reasonable to manage low-risk CD patients conservatively and initiate treatment only if there is endoscopic recurrence at 6 months. However, it might be wise to initiate biologic therapy postoperatively for high-risk CD patients despite the findings of this study of no significant impact of biologics on the rate of postoperative recurrence.…”

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

“…Altogether 87 articles were selected for detailed evaluation, among which 24 articles were included (Figure 1). Generally, articles originated from Europe, 21‐36 Japan, 28,37‐41 the United States 42,43 and Oceania, 44 comprising 11 RCTs, 23,26,29,32,34,36,38,39,41,43,44 and 13 cohort or case‐control studies 21,22,24,25,27,28,30,31,33,35,37,40,42 . Most of the articles prescribed anti‐TNF‐α therapy, either with infliximab or adalimumab, with one article using vedolizumab.…”

Patient sex does not affect endoscopic outcomes of biologicals in inflammatory bowel disease but is associated with adverse events

“…Several studies employed similar outcome measures (e.g. post-operative recurrence [31,39,55] or mucosal healing after 1 year [29,45,66]) and were thus suitable for meta-analysis. However, the studies in both the primary and the secondary outcomes did not report exact summary measures or the frequencies in which the outcomes of interest occurred in male and female patients.…”

“…Of the included studies involving multiple biologicals, seven examined a population treated with adalimumab or infliximab [15,25,31,39,46,48,51,55,64] and one concerned IBD patients treated with adalimumab, certolizumab or infliximab [36]. The first group of studies were all of a retrospective nature, with varying populations of CD patients, UC patients or both, as described in Table 2.…”