Does long-term efficacy differ between infliximab and adalimumab after 1 year of continuous administration?

Abstract

Although biologics are important inflammatory bowel disease therapies, loss of response (LOR) remains problematic. We evaluated LOR to biologics in our Crohn disease (CD) patients receiving biologics. Of 137 biologic-treated CD patients, 68 continuously receiving the same biologic type for at least 1 year were divided into 2 groups: infliximab (IFX) (n = 39) and adalimumab (ADA) (n = 29). Clinical courses were compared at biologic introduction and at 1 year. Both groups were retrospectively analyzed for LOR at and beyond 1 year after biologic introduction (study endpoint). Patients were then divided into LOR and non-LOR groups to identify factors predicting LOR. At 1 year after biologic introduction, decreases in CD activity index were 94 ± 105 in the IFX and 102 ± 89 in the ADA group, not significantly different. Blood test data did not differ between these groups. LOR occurred in 14 IFX and 5 ADA group patients. Event-free rates at 5 years after biologic introduction were 62% in the IFX and 61% in the ADA group. Patients achieving clinical remission 1 year after biologic introduction accounted for 69% of the IFX and 90% of the ADA group, while respective rates of secondary LOR at 5 years were 32% and 26%. C-reactive protein (CRP) at biologic introduction (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.04–2.06; P = .02) and age at CD onset (OR, 1.1; 95% CI, 1.01–1.20; P = .03) predicted LOR. As to IFX and ADA efficacies after 1 year of administration, there were no significant differences in event-free rates for the 5 years after biologic introduction or the secondary LOR rate. CRP at biologic introduction and age at CD onset predicted LOR.

Loss of response to scheduled infliximab therapy for Crohn's disease in adults: A systematic review and meta‐analysis

“…In a large retrospective and prospective multicenter study for identify- was identified as a predictive factor for LOR. 26 Similar results were observed in our study; patients with younger age at CD onset were more likely to suffer from LOR after initiating IFX therapy.…”

Long‐term outcomes of patients with Crohn's disease who received infliximab or adalimumab as the first‐line biologics

“…The short‐term efficacy, including achievement of steroid‐free remission, and the continuation of the first anti‐TNF agent were similar between the patients treated with IFX first and those treated with ADA first, and these results were consistent with those reported in previous studies . The similarity of our patient characteristics and short‐term outcomes with those in previous studies suggests a high level of confidence in the quality of our long‐term outcome analysis, which is the highlight of the current study.…”

“…No head‐to‐head comparisons have been performed regarding which agent, IFX or ADA, should be administered first for biologic‐naïve CD patients. Therefore, several retrospective and a few prospective studies have compared the rates of clinical or steroid‐free remission, surgery, loss of response (LOR), and adverse events between patients who received IFX first and those who received ADA first . However, most of these previous reports evaluated relatively short‐term outcomes only and discontinued observation of patient clinical courses at the first episode of LOR.…”

“…Therefore, several retrospective and a few prospective studies have compared the rates of clinical or steroid-free remission, surgery, loss of response (LOR), and adverse events between patients who received IFX first and those who received ADA first. [2][3][4][5][6][7][8][9][10][11][12][13][14] However, most of these previous reports evaluated relatively short-term outcomes only and discontinued observation of patient clinical courses at the first episode of LOR. Therefore, long-term outcomes of the patients who were administered each agent as the first-line biologic have scarcely been reported.…”

Efficacy of ustekinumab against infliximab-induced psoriasis and arthritis associated with Crohn’s disease

“…Furthermore, higher therapeutic goals beyond clinical remission alone, such as mucosal healing and deep remission, have also been pursued. However, some problems associated with the use of anti-TNFα drugs have been identified, such as the onset of secondary failure, in which the drugs become progressively less effective with time, 1 – 3 and the occurrence of paradoxical skin reactions, eg, psoriatic manifestations. 4 , 5 …”