Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6091-6104
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6091
Efficacy and safety of adalimumab in comparison to infliximab for Crohn's disease: A systematic review and meta-analysis
Hua-Hua Yang, Yi Huang, Xu-Chun Zhou, Ruo-Nan Wang
Hua-Hua Yang, Yi Huang, Xu-Chun Zhou, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Ruo-Nan Wang, Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
Author contributions: Yang HH and Zhou XC contributed to study design; Yang HH, Huang Y, and Wang RN contributed to the literature search; Yang HH, Huang Y, and Zhou XC participated in data extraction and analysis; Yang HH and Huang Y wrote the paper.
Conflict-of-interest statement: Nothing to disclosed.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu-Chun Zhou, MD, Professor, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. chqxchzh@163.com
Received: December 29, 2021
Peer-review started: December 29, 2021
First decision: January 25, 2022
Revised: February 14, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: June 26, 2022
Abstract
BACKGROUND

Adalimumab (ADA) and infliximab (IFX) are the cornerstones of the treatment of Crohn’s disease (CD). It remains controversial whether there is a difference in the effectiveness and safety between IFX and ADA for CD.

AIM

To perform a meta-analysis to compare the effectiveness and safety of ADA and IFX in CD.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Cohort studies were considered for inclusion. The primary outcomes were induction of response and remission, maintenance of response and remission, and secondary loss of response. Adverse events were secondary outcomes.

RESULTS

Fourteen cohort studies were included. There was no apparent difference between the two agents in the induction response [odds ratio (OR): 1.27, 95% confidence interval (CI): 0.93-1.74, P = 0.14] and remission (OR: 1.11, 95%CI: 0.78–1.57, P = 0.57), maintenance response (OR: 1.08, 95%CI: 0.76–1.53, P = 0.67) and remission (OR: 1.26, 95%CI: 0.87–1.82, P = 0.22), and secondary loss of response (OR: 1.01, 95%CI: 0.65–1.55, P = 0.97). Subgroup analysis revealed ADA and IFX had similar rates of response, remission, and loss of response either in anti-tumor necrosis factor-α naïve or non-naïve patients. Further, there was a similar result regardless of whether CD patients were treated with optimized therapy, including dose intensification, shortening interval, and combination immunomodulators. However, ADA had a fewer overall adverse events than IFX (OR: 0.62, 95%CI: 0.42–0.91, P = 0.02).

CONCLUSION

ADA and IFX have similar clinical benefits for anti-tumor necrosis factor-α naïve or non-naïve CD patients. Overall adverse events rate is higher in patients in the IFX group.

Keywords: Crohn disease, Adalimumab, Infliximab, Clinical efficacy, Adverse effects, Meta-analysis

Core Tip: Differences in immunogenicity and route of administration among adalimumab (ADA) and infliximab (IFX) allow for potential variability in therapeutic properties and efficacy. However, clear recommendations have been limited due to a lack of head-to-head comparison. We conducted a meta-analysis to synthesize current results and compared the efficacy and safety of ADA and IFX. The results showed that both have similar clinical benefits for anti-tumor necrosis factor-α naïve or non-naïve Crohn’s disease patients. Overall adverse events rate is higher in patients in the IFX group. ADA and IFX can be selected based on a possible history of adverse events and patient compliance.