Efficacy and safety of adalimumab in comparison to infliximab for Crohn's disease: A systematic review and meta-analysis

Abstract

Background: Adalimumab (ADA) and infliximab (IFX) are the cornerstones of the treatment of Crohn's disease (CD). It remains controversial whether there is a difference in the effectiveness and safety between IFX and ADA for CD.

Aim: To perform a meta-analysis to compare the effectiveness and safety of ADA and IFX in CD.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Cohort studies were considered for inclusion. The primary outcomes were induction of response and remission, maintenance of response and remission, and secondary loss of response. Adverse events were secondary outcomes.

Results: Fourteen cohort studies were included. There was no apparent difference between the two agents in the induction response [odds ratio (OR): 1.27, 95% confidence interval (CI): 0.93-1.74, P = 0.14] and remission (OR: 1.11, 95%CI: 0.78-1.57, P = 0.57), maintenance response (OR: 1.08, 95%CI: 0.76-1.53, P = 0.67) and remission (OR: 1.26, 95%CI: 0.87-1.82, P = 0.22), and secondary loss of response (OR: 1.01, 95%CI: 0.65-1.55, P = 0.97). Subgroup analysis revealed ADA and IFX had similar rates of response, remission, and loss of response either in anti-tumor necrosis factor-α naïve or non-naïve patients. Further, there was a similar result regardless of whether CD patients were treated with optimized therapy, including dose intensification, shortening interval, and combination immunomodulators. However, ADA had a fewer overall adverse events than IFX (OR: 0.62, 95%CI: 0.42-0.91, P = 0.02).

Conclusion: ADA and IFX have similar clinical benefits for anti-tumor necrosis factor-α naïve or non-naïve CD patients. Overall adverse events rate is higher in patients in the IFX group.

Keywords: Adalimumab; Adverse effects; Clinical efficacy; Crohn disease; Infliximab; Meta-analysis.

Figure 1

Flow chart for literature search. IFX: Infliximab; ADA: Adalimumab; CTZ: Certolizumab; CD: Crohn’s disease; UC: Ulcerative colitis.

Figure 2

Forest plot for induction efficacy comparing adalimumab and infliximab. A: Induction of response; B: Induction of remission. ADA: Adalimumab; IFX: Infliximab; CI: Confidence interval.

Figure 3

Forest plot for maintenance efficacy comparing adalimumab and infliximab. A: Maintenance of response; B: Maintenance of remission. ADA: Adalimumab; IFX: Infliximab; CI: Confidence interval.

Figure 4

Forest plot comparing infliximab and adalimumab for the incidence of secondary loss of response. ADA: Adalimumab; IFX: Infliximab; CI: Confidence interval.

Figure 5

Forest plot for comparisons of the rate of adverse events for adalimumab and infliximab. A: Overall adverse events; B: Severe adverse events; C: Opportunistic infection. ADA: Adalimumab; IFX: Infliximab; CI: Confidence interval.

Figure 6

Funnel plot. A: Maintenance of response; B: Maintenance of remission; C: Secondary loss of response; D: Overall adverse events. OR: Odds ratio; SE: Standard error.