Adalimumab or infliximab as monotherapy, or in combination with an immunomodulator, in the treatment of Crohns diseaseReport as inadecuate

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* Corresponding author 1 UPMC - Université Pierre et Marie Curie - Paris 6 2 Service de Gastroentérologie et nutrition CHU Saint-Antoine

Abstract : Background: The comparative efficacy of adalimumab ADA and infliximab IFX in Crohn-s disease, and the benefit of initial combotherapy with an immunomodulator, are debated.Aim: To assess the best anti-TNF treatment regimens in Crohn-s disease.Methods: We included 906 biologic-naïve Crohn-s disease patients median age, 31 years 24–41 and performed a retrospective analysis of 1284 therapeutic exposures to ADA n = 521 or IFX n = 763 between 2006 and 2015. An immunomodulator was associated during the first 4–6 months initial combotherapy during 706 therapeutic exposures 55%. Median duration of anti-TNF therapy was 39 months IQR 17–67. Primary outcomes were 6-month and 2-year response rates and drug survival. Logistic regression with propensity scoring and Cox proportional hazard analysis determined variables associated with outcomes.Results: The response rates at 6 months and 2 years were 64% and 44% on ADA mono, 86% and 70% on ADA combo, 72% and 45% on IFX mono, and 84% and 68% on IFX combotherapy, respectively. Differences between ADA and IFX were not significant, whereas combotherapy was superior to monotherapy P < 0.001. Drug survival was longer with combotherapy vs. monotherapy adjusted hazard ratio 2.17 1.72–2.70 and not significantly different between ADA and IFX. During subsequent anti-TNF exposures, IFX combotherapy fared better than other groups regarding response rates, drug survival, disease activity, hospitalisations and abdominal surgery.Conclusion: In this retrospective analysis of a large tertiary centre cohort of Crohn-s disease patients, ADA and IFX had similar efficacy as first line treatment, while initial combotherapy with an immunomodulator improved all outcome measures.

Keywords : Adalimumab infliximab immunotherapy Crohn-s disease

Author: J. Cosnes - H. Sokol - A. Bourrier - I. Nion-Larmurier - A. Wisniewski - C. Landman - P. Marteau - L. Beaugerie - K. Perez - P. S



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