Comparison of Infliximab and Adalimumab in Biologic-Naive Patients With Ulcerative Colitis: A Nationwide Danish Cohort Study

Siddharth Singh, Nynne Nyboe Andersen, Mikael Andersson, Edward V. Loftus, Tine Jess

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1218-1225.e7
JournalClinical Gastroenterology and Hepatology
Issue number8
StatePublished - Aug 2017


  • Biologics
  • Comparative Effectiveness
  • Inflammatory Bowel Disease
  • Propensity Matching

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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