TY - JOUR
T1 - Comparison of Infliximab and Adalimumab in Biologic-Naive Patients With Ulcerative Colitis
T2 - A Nationwide Danish Cohort Study
AU - Singh, Siddharth
AU - Andersen, Nynne Nyboe
AU - Andersson, Mikael
AU - Loftus, Edward V.
AU - Jess, Tine
N1 - Publisher Copyright:
© 2017 AGA Institute
PY - 2017/8
Y1 - 2017/8
N2 - Background & Aims This study compares the effectiveness and safety of infliximab and adalimumab in biologic-naive patients with ulcerative colitis (UC), in a nationwide register-based propensity score–matched cohort study. Methods From 1719 adults with UC, between ages 15 and 75 years in Denmark treated with either infliximab or adalimumab as their first biologic agent, we compared rates of all-cause hospitalization, UC-related hospitalization, major abdominal surgery, and serious infections after a variable 2:1 propensity score matching, accounting for baseline clinical characteristics, disease severity, health care utilization, and use of UC-related medications. Results As compared with infliximab-treated patients, adalimumab-treated patients had higher rate of all-cause hospitalization (hazard ratio [HR], 1.84; 95% CI, 1.18–2.85) and a trend toward higher rate of UC-related hospitalization (HR, 1.71; 95% CI, 0.95–3.07), particularly in a stratum of patients on concomitant immunomodulator therapy. However, risk of abdominal surgery (HR, 1.35; 95% CI, 0.62–2.94) was not different between the 2 treatment groups. Risk of serious infection requiring hospitalization was significantly higher in adalimumab-treated patients (HR, 5.11; 95% CI, 1.20–21.80). Conclusions In this nationwide propensity score matched–cohort study of biologic-naive adults with UC, use of adalimumab as first-line biologic over infliximab was associated with higher risk of hospitalization and serious infections, although risk of surgery was not different. In the absence of head-to-head trials, this evidence may assist patients, health care providers, purchasers, and policy makers to make informed decisions that may improve health care in UC.
AB - Background & Aims This study compares the effectiveness and safety of infliximab and adalimumab in biologic-naive patients with ulcerative colitis (UC), in a nationwide register-based propensity score–matched cohort study. Methods From 1719 adults with UC, between ages 15 and 75 years in Denmark treated with either infliximab or adalimumab as their first biologic agent, we compared rates of all-cause hospitalization, UC-related hospitalization, major abdominal surgery, and serious infections after a variable 2:1 propensity score matching, accounting for baseline clinical characteristics, disease severity, health care utilization, and use of UC-related medications. Results As compared with infliximab-treated patients, adalimumab-treated patients had higher rate of all-cause hospitalization (hazard ratio [HR], 1.84; 95% CI, 1.18–2.85) and a trend toward higher rate of UC-related hospitalization (HR, 1.71; 95% CI, 0.95–3.07), particularly in a stratum of patients on concomitant immunomodulator therapy. However, risk of abdominal surgery (HR, 1.35; 95% CI, 0.62–2.94) was not different between the 2 treatment groups. Risk of serious infection requiring hospitalization was significantly higher in adalimumab-treated patients (HR, 5.11; 95% CI, 1.20–21.80). Conclusions In this nationwide propensity score matched–cohort study of biologic-naive adults with UC, use of adalimumab as first-line biologic over infliximab was associated with higher risk of hospitalization and serious infections, although risk of surgery was not different. In the absence of head-to-head trials, this evidence may assist patients, health care providers, purchasers, and policy makers to make informed decisions that may improve health care in UC.
KW - Biologics
KW - Comparative Effectiveness
KW - Inflammatory Bowel Disease
KW - Propensity Matching
UR - http://www.scopus.com/inward/record.url?scp=85015894787&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015894787&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2016.11.024
DO - 10.1016/j.cgh.2016.11.024
M3 - Article
C2 - 27913244
AN - SCOPUS:85015894787
SN - 1542-3565
VL - 15
SP - 1218-1225.e7
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -