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Review
. 2024 Jun 2;16(6):e61547.
doi: 10.7759/cureus.61547. eCollection 2024 Jun.

Efficacy and Safety of Infliximab Versus Adalimumab in Adult Subjects With Moderate to Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Ahmed Salman  1 , Mohamed A Salman  2 , Ahmed Elewa  3 , Asmaa M Awwad  4
Affiliations
Review

Efficacy and Safety of Infliximab Versus Adalimumab in Adult Subjects With Moderate to Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Ahmed Salman et al. Cureus. .

Abstract

Ulcerative colitis (UC) is an inflammatory disorder affecting the colon, and typically, during the disease course, the condition may exacerbate, relapse, and remit. One of the most successful lines for inducing and maintaining clinical remission in subjects with UC is biological therapy with anti-tumor necrosis factor α (anti-TNF) agents, including adalimumab (ADA) and infliximab (IFX). This meta-analysis is an attempt to obtain complementary information driven by real-world experience (RWE) concerning the efficacy and safety of two of the most popular anti-TNFs in treating UC. This is a systematic review and meta-analysis of RWE studies comparing ADA and IFX as naïve anti-TNF agents for the treatment of subjects with UC. Studies were obtained by searching Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials, Embase, and the PubMed Central databases. Patients treated with IFX showed significantly higher induction responses. No statistically significant difference was found in the comparison of response in the maintenance treatment period. Higher overall adverse events were related to IFX treatment, with serious adverse events that were nonsignificantly higher in the ADA-treated group. In conclusion, IFX demonstrated significantly higher induction responses compared to ADA in patients with moderate-to-severe UC. IFX was associated with higher overall adverse events, whereas serious adverse events were non-significantly higher in the ADA-treated group. IFX may be favored as a first-line agent for its induction efficacy, and the choice between IFX and ADA should be individualized based on comprehensive clinical evaluation.

Keywords: adalimumab; infliximab; meta-analysis; real-world experience; ulcerative colitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA 2020 study selection flow chart for new systematic reviews that included searchers of databases and registers
Figure 2
Figure 2. Forest plot for the induction response
References: [15,23,26]
Figure 3
Figure 3. Forest plot for the maintenance clinical response
References: [15,20,26]
Figure 4
Figure 4. Forest plot for the maintenance clinical remission
References: [17,20,26-28]
Figure 5
Figure 5. Forest plot for the mucosal healing
References: [20,24,26-28]
Figure 6
Figure 6. Forest plot for the pMS change
References: [17,25]
Figure 7
Figure 7. Forest plot for the new concomitant steroid use
References: [15,16,19,20,24]
Figure 8
Figure 8. Forest plot for the hazards ratios of new steroid use
References: [18,19,24,25]
Figure 9
Figure 9. Forest plot for the steroid-free remission
References: [15,20,26,28]
Figure 10
Figure 10. Forest plot for the UC-related hospitalization
References: [19,24]
Figure 11
Figure 11. Forest plot for the hazards ratios of hospitalization
References: [18,19,24,25]
Figure 12
Figure 12. Forest plot for the colectomy
References: [15,16,24,27]
Figure 13
Figure 13. Forest plot for the treatment persistence
References: [18,21-23,25,27]
Figure 14
Figure 14. Forest plot for the time to treatment withdrawal
References: [21,22,27]
Figure 15
Figure 15. Forest plot for the AEs
References: [1,2,19,21,23,25,28]
Figure 16
Figure 16. Forest plot for the serious AEs
References: [2,19,21,23,28]
Figure 17
Figure 17. Risk of bias summary
See this image and copyright information in PMC

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