Adalimumab vs Infliximab in Luminal Pediatric Crohn's Disease: Comparable Outcomes in a Prospective Multicenter Cohort Study

INTRODUCTION: This study compared real-world effectiveness between adalimumab (ADA) and infliximab (IFX) in children with Crohn's disease (CD). METHODS: Children enrolled into the prospective Canadian Children Inflammatory Bowel Disease Network National Inception Cohort between 2014 and 2020 who commenced ADA or IFX as first antitumor necrosis factor (anti-TNF) agent for luminal CD were included. Multivariate logistic regression modeled the propensity of commencing ADA; propensity score matching was used to match IFX-treated children to ADA-treated children. The primary outcome at 1 year was steroid-free clinical remission (SFCR). Secondary outcomes at 1 year were (i) combined SFCR and C-reactive protein remission, (ii) treatment intensification, and (iii) anti-TNF durability. Odds ratios (ORs) and hazard ratio adjusted for concomitant immunomodulator use with 95% confidence interval (CI) are reported. RESULTS: In the propensity score-matched cohort of 147 ADA-treated and 147 IFX-treated children, 92 (63%) ADA-treated and 87 (59%) IFX-treated children achieved SFCR at 1 year (adjusted OR 1.4, 95% CI 0.9–2.4); 75 of 140 (54%) ADA-treated and 85 of 144 (59%) IFX-treated children achieved combined SFCR and C-reactive protein remission (adjusted OR 1.0, 95% CI 0.6–1.6). ADA-treated children less frequently underwent treatment intensification (21 [14%]) compared with IFX-treated children (69 [47%]) ( P < 0.0001). Discontinuation of anti-TNF occurred in 18 (12%) ADA-treated and 15 (10%) IFX-treated children (adjusted hazard ratio 1.2, 95% CI 0.6–2.2). DISCUSSION: Children with CD achieved favorable outcomes at 1 year with either ADA or IFX as first anti-TNF agents. Those receiving IFX did not have significantly superior outcomes compared with clinically similar children receiving ADA.