Original Article

Digestive Diseases and Sciences

, Volume 58, Issue 1, pp 209-215

Comparative Effectiveness of Anti-TNF Agents for Crohn’s Disease in a Tertiary Referral IBD Practice

  • Seema A. PatilAffiliated withDivision of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine
  • , Ankur RustgiAffiliated withDivision of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine
  • , Patricia LangenbergAffiliated withDepartment of Epidemiology and Public Health, School of Medicine, University of Maryland
  • , Raymond K. CrossAffiliated withDivision of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of MedicineVeterans Affairs, Maryland Heath Care System Email author 

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Abstract

Background

The three Food and Drug Administration (FDA)-approved anti-tumor necrosis factor drugs (anti-TNFs) for Crohn’s disease (CD) have not been directly compared.

Aim

To compare the efficacy of the three anti-TNFs for CD in clinical practice.

Methods

Retrospective review of patients initiated on anti-TNF between 2004 and 2008. Disease activity, quality of life, and remission rates were compared between groups over 1 year.

Results

Sixty patients with CD were initiated on anti-TNF from 2004 to 2008: 31 on infliximab (IFX) and 29 on adalimumab (ADA) or certolizumab pegol (CTZ). More patients in the ADA/CTZ scores group had prior exposure to anti-TNF (76 versus 10 %, p < 0.01). Mean Harvey–Bradshaw Index (HBI) scores in the IFX group were lower than in the ADA/CTZ group at 12 months (2.72 ± 3.34 versus 5.63 ± 5.33, p = 0.03). At 12 months, more IFX patients were in remission compared with those on ADA/CTZ (88 versus 53 %, p ≤ 0.01). Mean Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores were not different between the IFX and ADA/CTZ groups at 12 months. Stratified analyses and logistic regression based on prior anti-TNF use did not show differences in remission rates at any time point post-baseline between groups.

Conclusions

After adjustment for prior anti-TNF there was no difference in remission rates between the IFX and ADA/CTZ groups at any time point post-baseline. This suggests that differences between groups were accounted for by a higher rate of prior anti-TNF in the ADA/CTZ group. Our results should be reviewed with caution given the small sample size.

Keywords

Crohn’s disease Anti-TNF therapy Infliximab Adalimumab Certolizumab pegol