Infliximab superior to adalimumab in bio-naïve patients with FCD

A recent study has shown infliximab’s superiority over adalimumab in the treatment of bio-naïve patients with fistulizing Crohn’s disease (FCD). However, there is no therapeutic difference seen in bio-exposed FCD.

The authors analysed the persistence of all dispensed biological agents from the Australian Pharmaceutical Benefits Scheme registry data 2005‒2021 for FCD. They also performed propensity score matching to account for baseline cohort imbalance.

A total of 5,739 lines of therapy in 4,466 patients over the 16-year period were analysed, with 17,144 patient-years of follow-up. Specifically, 2,605 of 5,739 (45.4 percent) used adalimumab, and 3,134 (54.6 percent) used infliximab. Moreover, 1,697 (29.6 percent) used thiopurine cotherapy at induction, and 242 (4.2 percent) used methotrexate.

As a first-line biologic (biologic-naïve), infliximab was superior to adalimumab in overall (p=0.0002) and corticosteroid-free persistence (p=0.0021). When used after first-line (biologic-exposed), no difference was noted for overall persistence (p=0.064) between agents, but infliximab exhibited greater corticosteroid-free persistence (p=0.030).

Furthermore, coinduction with thiopurine correlated with improved overall (p=0.0002) and corticosteroid-free persistence (p=0.045)

After propensity score matching, infliximab remained superior to adalimumab for overall (p<0.0001) and corticosteroid-free persistence (p=0.0016) in bio-naïve (p<0.0001 and p=0.0016, respectively), but not bio-exposed (p=0.12 and p=0.074, respectively), patients.

Likewise, thiopurine correlated with superior overall and corticosteroid-free persistence, but no difference was observed with methotrexate.

“Thiopurine cotherapy was independently associated with improved biological agent persistence in FCD,” the authors said.