DDW 2018: Infliximab Appears to Be Superior to Adalimumab in Maintaining Remission of Ulcerative Colitis
June 5, 2018—Washington, DC—Infliximab has been proven superior to adalimumab in maintaining remission of ulcerative colitis, as demonstrated by improvement in Simple Clinical Colitis Activity Index scores and treatment continuation at 52 weeks.
This outcome of a retrospective, multicenter case-control study was presented at Digestive Disease Week (DDW) 2018, from June 2 – 5.
Victoria Tatiana Kronsten, MD, of King's College Hospital National Health Service Trust, London, UK, explained that anti-tumor necrosis factor therapy has revolutionized the treatment of ulcerative colitis, particularly in moderate to severe disease.
Though response rates are significantly greater than placebo, these drugs tend to perform less well in maintaining remission.
Route of administration may influence efficacy. A 2014 network meta-analysis of trial data indicated the superiority of intravenous (infliximab) over subcutaneous (adalimumab) drugs. Dr. Kronsten and colleagues set to compare the efficacy of these two drugs.
Patients administered infliximab or adalimumab as their first biologic, identified from databases of 5 UK hospitals, were studied if they had completed induction dosing and entered the maintenance phase.
Patients receiving infliximab as “rescue” therapy were excluded. Data were collected and compared for prebiologic disease activity (Simple Clinical Colitis Activity Index, C-reactive protein, and calprotectin) and throughout anti-tumor necrosis factor therapy.
The primary endpoint for comparison was the number of patients remaining in clinical remission after 52 weeks (combined continuation of infliximab or adalimumab therapy and Simple Clinical Colitis Activity Index score ≤3).
Data were collected for the duration of therapy, or up to last follow-up, if beyond 52 weeks.
In all, 63 infliximab (40.7 ± 15.4 years of age, 28 female) and 62 adalimumab (36.4 ± 14.3 years of age, 28 female) patients were analyzed.
No statistically significant differences were observed in demographics or prebiologic disease activity between the two groups.
Median Simple Clinical Colitis Activity Index score at 14 weeks was significantly lower in the infliximab (2 [0 - 4]) than in the adalimumab (4 [2 - 8]) group, P= .01.
After 52 weeks, 46 (73%) of patients in the infliximab and 29 (47%) of those in the adalimumab group had remained on therapy (P = .005) and in remission (22 [35%] vs 5 [8%]), P = .0006. Primary nonresponse was the reason for treatment cessation in 14 (23%) adalimumab and 4 (6%) of infliximab patients (P = .02).
Dr. Kronsten concluded that these results from a real-world cohort mirrored those produced in the network meta-analysis of clinical trials for these agents.
They suggested that infliximab was superior to adalimumab for maintaining remission of ulcerative colitis. This superiority was demonstrated by improvement in median Simple Clinical Colitis Activity Index score scores and treatment continuation at 52 weeks.
No significant differences in colectomy rates, hospital admission for acute flares, or adverse events were observed.
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