Comparison of long-term outcomes of infliximab vs. adalimumab as treatment for ulcerative colitis in biologic-naive patients

Abstract

Background/Aim: Tumor necrosis factor (TNF)-α inhibitors infliximab and adalimumab are standard treatments for moderate to severe ulcerative colitis (UC). However, there has been no head-to-head comparison of the treatment efficacy and outcomes between the two agents. The aim of this study was to compare the efficacy and long-term outcomes of infliximab vs. adalimumab in biologic-naïve patients with UC. Methods: We retrospectively analyzed the records of 113 biologic-naïve patients with UC who received between September 2012 and December 2017. We compared remission and response rates between groups at 8 and 52 weeks. We used Kaplan-Meier curves to compare long term outcomes and logistic regression analysis and Cox-proportional hazard regression models to assess factors affecting outcomes. Results: The median follow-up duration was 25.8 months. Baseline clinical characteristics were similar between groups. There were no significant differences between the two groups in the rates of clinical remission and clinical response at 8 and 52 weeks. Multivariate analyses showed long term outcomes, including all-cause hospitalization, UC-related hospitalization, corticosteroid prescription, discontinuation of TNF-α inhibitor therapy, and switching to a secondary TNF-α inhibitor were not significantly different between groups. Elevated C-reactive protein level (more than 5 mg/L) was a significant predictive factor for poor outcomes. During the follow-up period, the rates of adverse event were not statistically different between the two groups. There were no cases of discontinuation of treatment because of adverse event. Conclusion: Infliximab and adalimumab have similar treatment efficacy and long-term outcomes in biologic-naïve patients with moderate to severe UC.