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Adalimumab vs Infliximab in Luminal Pediatric Crohn's Disease: Comparable Outcomes in a Prospective Multicenter

Jennifer C deBruyn1, Hien Q Huynh2, Anne M Griffiths3,4

  • 1Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.

The American Journal of Gastroenterology
|October 3, 2023
PubMed

Insights

In pediatric Crohn's disease (CD), both adalimumab (ADA) and infliximab (IFX) as first anti-tumor necrosis factor (anti-TNF) therapies yield comparable outcomes at one year. Treatment intensification was less frequent with ADA compared to IFX.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Clinical Therapeutics

Background:

  • Crohn's disease (CD) is a chronic inflammatory condition affecting children.
  • Anti-tumor necrosis factor (anti-TNF) agents like adalimumab (ADA) and infliximab (IFX) are crucial for managing pediatric CD.
  • Real-world effectiveness data comparing ADA and IFX as initial anti-TNF therapy in children is essential.

Purpose of the Study:

  • To compare the real-world effectiveness of adalimumab (ADA) versus infliximab (IFX) as the first anti-TNF agent in children with Crohn's disease (CD).
  • To evaluate outcomes including clinical remission, combined remission, treatment intensification, and anti-TNF durability at one year.

Main Methods:

  • A prospective cohort study of children with luminal CD initiating ADA or IFX as their first anti-TNF agent.
  • Propensity score matching was employed to create comparable groups of ADA- and IFX-treated children.
  • Outcomes assessed at one year included steroid-free clinical remission (SFCR), combined SFCR and C-reactive protein remission, treatment intensification, and anti-TNF durability.

Main Results:

  • In the matched cohort (147 ADA, 147 IFX), SFCR at one year was achieved by 63% of ADA-treated and 59% of IFX-treated children (aOR 1.4).
  • Combined SFCR and C-reactive protein remission was similar between groups (54% ADA vs. 59% IFX; aOR 1.0).
  • Treatment intensification was significantly lower in the ADA group (14%) compared to the IFX group (47%) (P < 0.0001). Anti-TNF discontinuation rates were similar.

Conclusions:

  • Both adalimumab and infliximab demonstrate favorable one-year outcomes when used as first-line anti-TNF therapy in pediatric Crohn's disease.
  • While clinical remission rates were comparable, adalimumab was associated with less frequent treatment intensification compared to infliximab.
Abstract

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