Adalimumab Versus Ustekinumab in Egyptian Patients with Moderate to Severe Inflammatory Bowel Disease: A Cohort Study

Abstract

Inflammatory bowel disease (IBD) is a progressive, relapsing disorder. Biologics for patients with moderate-to-severe IBD have shown promising therapeutic outcomes. This research aims to compare the efficacy, safety and cost of adalimumab versus ustekinumab in a group of patients with IBD who failed treatment with infliximab. A prospective cohort study was performed on 108 patients, 53 of whom received adalimumab (Gp A) and 55 received ustekinumab (Gp U), followed up for 24 weeks. Clinical response, clinical remission and C-reactive protein (CRP) normalisation were assessed for efficacy; a cost-effectiveness analysis was conducted, and safety was evaluated. The clinical response was achieved by 86.8% of the patients in the Gp A and 92.7% of those in the Gp U group, respectively, without a significant statistical difference. The patients in the Gp A group experienced clinical remission and CRP normalisation in proportions of 47.1% and 37.3%, respectively. In contrast, the patients in the Gp U group experienced 69.8% and 58.5%, respectively, with significant statistical differences between the two groups. Adverse events were fewer in the Gp U than in the Gp A group, with a significant statistical difference. Ustekinumab was more costly than adalimumab, with a significant statistical difference between both groups. In conclusion, ustekinumab is considered more effective and safer than adalimumab in infliximab-experienced patients but with a higher cost in patients with moderate to severe IBD.