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Comparative Effectiveness of Anti-TNF Agents for Crohn’s Disease in a Tertiary Referral IBD Practice

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Abstract

Background

The three Food and Drug Administration (FDA)-approved anti-tumor necrosis factor drugs (anti-TNFs) for Crohn’s disease (CD) have not been directly compared.

Aim

To compare the efficacy of the three anti-TNFs for CD in clinical practice.

Methods

Retrospective review of patients initiated on anti-TNF between 2004 and 2008. Disease activity, quality of life, and remission rates were compared between groups over 1 year.

Results

Sixty patients with CD were initiated on anti-TNF from 2004 to 2008: 31 on infliximab (IFX) and 29 on adalimumab (ADA) or certolizumab pegol (CTZ). More patients in the ADA/CTZ scores group had prior exposure to anti-TNF (76 versus 10 %, p < 0.01). Mean Harvey–Bradshaw Index (HBI) scores in the IFX group were lower than in the ADA/CTZ group at 12 months (2.72 ± 3.34 versus 5.63 ± 5.33, p = 0.03). At 12 months, more IFX patients were in remission compared with those on ADA/CTZ (88 versus 53 %, p ≤ 0.01). Mean Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores were not different between the IFX and ADA/CTZ groups at 12 months. Stratified analyses and logistic regression based on prior anti-TNF use did not show differences in remission rates at any time point post-baseline between groups.

Conclusions

After adjustment for prior anti-TNF there was no difference in remission rates between the IFX and ADA/CTZ groups at any time point post-baseline. This suggests that differences between groups were accounted for by a higher rate of prior anti-TNF in the ADA/CTZ group. Our results should be reviewed with caution given the small sample size.

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Abbreviations

CD:

Crohn’s disease

IBD:

Inflammatory bowel disease

EIM:

Extraintestinal manifestations

IFX:

Infliximab

ADA:

Adalimumab

CTZ:

Certolizumab pegol

HBI:

Harvey–Bradshaw Index

SIBDQ:

Short Inflammatory Bowel Disease Questionnaire

CDAI:

Crohn’s Disease Activity Index

IBDQ:

Inflammatory Bowel Disease Questionnaire

IM:

Immunomodulator

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Conflict of interest

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Seema A. Patil, Ankur Rustgi & Raymond K. Cross

  2. Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA

    Patricia Langenberg

  3. Veterans Affairs, Maryland Heath Care System, 100 North Greene Street, Lower Level, Baltimore, MD, 21201, USA

    Raymond K. Cross

Authors
  1. Seema A. Patil
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  2. Ankur Rustgi
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  3. Patricia Langenberg
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  4. Raymond K. Cross
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Correspondence to Raymond K. Cross.

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Patil, S.A., Rustgi, A., Langenberg, P. et al. Comparative Effectiveness of Anti-TNF Agents for Crohn’s Disease in a Tertiary Referral IBD Practice. Dig Dis Sci 58, 209–215 (2013). https://doi.org/10.1007/s10620-012-2323-0

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  • DOI: https://doi.org/10.1007/s10620-012-2323-0

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