Adalimumab versus infliximab for the treatment of moderate to severe ulcerative colitis in adult patients naïve to anti-TNF therapy: An indirect treatment comparison meta-analysis

Abstract

ObjectiveTo compare the efficacy of adalimumab and infliximab for the treatment of moderate to severe ulcerative colitis using indirect treatment comparison meta-analysis. MethodsA systematic review and Bayesian indirect treatment comparison meta-analyses were performed for seven patient-important clinical outcomes at 8weeks and 52weeks. Odds ratio (OR) estimates and associated 95% credible intervals (CrIs) were produced. ResultsFive eligible RCTs informed clinical remission, response, mucosal healing, quality of life, colectomy, serious adverse events, and discontinuation due to adverse events at 8weeks and 52weeks. At 8weeks of induction therapy, clinical remission (OR=0.42, 95% CrI 0.17–0.97), clinical response (OR=0.45, 95% CrI 0.23–0.89) and mucosal healing (OR=0.46, 95% CrI 0.25–0.86) statistically favored infliximab. However, after 52weeks of maintenance therapy OR estimates showed no significant difference between infliximab and adalimumab. For serious adverse events and discontinuations due to adverse events, adalimumab and infliximab were similar to placebo. Further, the indirect treatment comparison of adalimumab and infliximab yielded odds ratios close to 1.00 with wide credible intervals. ConclusionThe findings of this indirect treatment comparison meta-analysis suggest that both infliximab and adalimumab are superior to placebo in the treatment of moderate to moderately severe ulcerative colitis. While infliximab is statistically more effective than adalimumab in the induction of remission, response and mucosal healing at 8weeks, infliximab and adalimumab are comparable in efficacy at 52weeks of maintenance treatment.