Infliximab and adalimumab have similar efficacy in Crohn’s

A real-world study of Australian and New Zealand patients concludes that infliximab and adalimumab have similar efficacy in Crohn’s disease.

However the observational four-year study found infliximab required a concomitant immunomodulator in order to maintain an optimal response compared to adalimumab monotherapy.

According to the authors led by Associate Professor Graham Radford-Smith, group leader of the IBD Program at QIMR Berghofer Medical Research Institute and Royal Brisbane Hospital, the study results will assist clinicians in further optimising patient care in their day-to-day clinical practice.

Speaking to the limbic Professor Radford-Smith said infliximab was more immunogenic due to its 25% murine component.

“The SONIC trial in 2010 found that the best outcomes were achieved with a combination of infliximab and azathioprine. We’ve underlined the significance of that finding in a large real-world study,” he said.

However he said there was no benefit to the duration of treatment response by taking immunomodulators 100% of the time.

“The sweet spot in terms of the survival curves is between 50 and 100% which is closer to the real world scenario when you consider patients sometimes forget to take their medication or let their script run out.”

The study of 327 patients from nine IBD centres in the Australian and New Zealand IBD Consortium showed no benefit in combining immunomodulator therapy with adalimumab.

Associate Professor Radford-Smith said the concomitant use of immunomodulators with infliximab was cost effective in maintaining patients on the original biologic, which was now cheaper due to the arrival of biosimilars.

“If we had a higher rate of antibody formation, then patients would have had to move onto other, potentially more costly biologics,” he said.

The study found an 8-13-fold increase in disease flares in patients who were treated with corticosteroids prior to anti-TNF treatment.

“The role of corticosteroids as a risk factor for flares definitely requires further investigation,” he said.

“We looked at multiple clinical variables and couldn’t find any association with disease burden. It could be that the impact of corticosteroids is related to the microbiome. We know that recurrent steroids can lead to thrush; what are they doing to gut flora deeper in the gastrointestinal tract?”

The study concluded patients with extensive disease, including perianal disease, or those with poor adherence to therapy may benefit from dual therapy with infliximab and immunomodulators.

Older patients with no adherence issues and but additional co-morbidities such as sun-related skin damage may benefit from adalimumab monotherapy.

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