Posted 3/16/2016 4:50 PM (GMT 0)
Research has started to compare drugs head to head. Humira (Adalimumab ,ADA) and Remicade (Infliximab ,IFX) came out pretty close after 1 year of treatment. No difference in hospitalizations, disease–related surgery, or steroid use. No clear difference in persistence of symptoms for UC, and only a slight advantage of Remicade lowering symptoms for CD patients.
There were over 1000 people in the study, but 70% to 80% had CD, so it might be that they did not have enough statistical power to find a Remicade advantage for UC. But, the CD advantage was modest. So, the two drugs are about equal - except Humira is a shot.
Inflammatory Bowel Diseases:
April 2016 - Volume 22 - Issue 4 - p 880–885
doi: 10.1097/MIB.0000000000000754
Original Clinical Articles
Comparative Effectiveness of Infliximab and Adalimumab in Crohn's Disease and Ulcerative Colitis
Ananthakrishnan, Ashwin N. MD, MPH; Cagan, Andrew BS; Cai, Tianxi PhD; Gainer, Vivian S. MS; Shaw, Stanley Y. MD, PhD; Savova, Guergana PhD; Churchill, Susanne PhD; Karlson, Elizabeth W. MD, MPH; Kohane, Isaac MD, PhD; Liao, Katherine P. MD, MPH; Murphy, Shawn N. MD, PhD
Collapse Box
Abstract
Background: The availability of monoclonal antibodies to tumor necrosis factor α has revolutionized management of Crohn's disease (CD) and ulcerative colitis. However, limited data exist regarding comparative effectiveness of these agents to inform clinical practice.
Methods: This study consisted of patients with CD or ulcerative colitis initiation either infliximab (IFX) or adalimumab (ADA) between 1998 and 2010. A validated likelihood of nonresponse classification score using frequency of narrative mentions of relevant symptoms in the electronic health record was applied to assess comparative effectiveness at 1 year. Inflammatory bowel disease–related surgery, hospitalization, and use of steroids were determined during this period.
Results: Our final cohort included 1060 new initiations of IFX (68% for CD) and 391 of ADA (79% for CD). In CD, the likelihood of nonresponse was higher in ADA than IFX (odds ratio, 1.62 and 95% CI, 1.21–2.17). Similar differences favoring efficacy of IFX were observed for the individual symptoms of diarrhea, pain, bleeding, and fatigue. However, there was no difference in inflammatory bowel disease–related surgery, hospitalizations, or prednisone use within 1 year after initiation of IFX or ADA in CD. There was no difference in narrative or codified outcomes between the 2 agents in ulcerative colitis.
Conclusions: We identified a modestly higher likelihood of symptomatic nonresponse at 1 year for ADA compared with IFX in patients with CD. However, there were no differences in inflammatory bowel disease–related surgery or hospitalizations, suggesting these treatments are broadly comparable in effectiveness in routine clinical practice.