Adalimumab on par with infliximab in luminal paediatric Crohn's disease

Use of either adalimumab or infliximab as first antitumour necrosis factor (anti-TNF) agent results in positive outcomes among children with Crohn’s disease (CD), a study has shown.

This study analysed children enrolled into the prospective Canadian Children Inflammatory Bowel Disease Network National Inception Cohort between 2014 and 2020 who initiated adalimumab or infliximab as first anti-TNF agent for luminal CD.

The authors used multivariate logistic regression to determine the tendency of commencing adalimumab and propensity score matching to match infliximab-treated children to those who received adalimumab. They also reported the odds ratios (ORs) and hazard ratio (HR) adjusted for concomitant immunomodulator use with 95 percent confidence interval (CI).

Steroid-free clinical remission (SFCR) at 1 year was the primary outcome, while secondary outcomes were combined SFCR and C-reactive protein (CRP) remission, treatment intensification, and anti-TNF durability.

In propensity score match analysis, 92 of 147 adalimumab-treated children (63 percent) and 87 of 147 infliximab-treated children (59 percent) achieved SFCR at 1 year (adjusted OR, 1.4, 95 percent CI, 0.9‒2.4). In addition, 75 of 140 adalimumab- (54 percent) and 85 of 144 infliximab-treated (59 percent) participants achieved the combined SFCR and CRP remission (adjusted OR, 1.0, 95 percent CI, 0.6‒1.6).

Children who received adalimumab were less likely to undergo treatment intensification when compared to those treated with infliximab (14 percent vs 47 percent; p<0.0001). Moreover, treatment discontinuation was similar between children who received adalimumab and those administered infliximab (12 percent vs 10 percent; adjusted HR, 1.2, 95 percent CI, 0.6‒2.2).

“Those receiving infliximab did not have significantly superior outcomes compared with clinically similar children receiving adalimumab,” the authors said.