Background Two anti-TNF drugs are approved to treat Crohn’s disease (CD) in Europe: infliximab and adalimumab.
Purpose To compare their efficacy and safety in adult patients with moderate to severe non-fistulizing CD.
Materials and methods A systematic review was undertaken. Databases: MEDLINE, EMBASE, the Cochrane Library, Centre for Reviews and Dissemination and Web of Science (until March 2013). Websites of health technology assessment (HTA) agencies and references from relevant studies were also reviewed to identify additional documents.
Systematic reviews, meta-analyses, network meta-analyses and HTA reports evaluating efficacy and/or safety of infliximab versus adalimumab (or both drugs versus a common comparator) in adults with moderate to severe non-fistulizing CD were included.
Study selection, quality assessment and data extraction were conducted by two independent researchers. Disagreements were resolved by consensus.
Results 8 studies met the inclusion criteria: 3 HTA reports, 1 Cochrane review, 1 network meta-analysis, 2 meta-analyses and 1 systematic review.
No head-to-head trials comparing infliximab and adalimumab were identified in any of the included studies. The best evidence available came from placebo-controlled randomised trials.
Despite the absence of direct evidence, in most cases indirect treatment comparisons (ITC) were considered inappropriate, due to the heterogeneity of trials. The only study in which an ITC was conducted failed to show significant differences between infliximab and adalimumab for the maintenance of remission or clinical response in patients with CD.
The remaining studies reached similar conclusions. In general, their authors considered that both infliximab and adalimumab were effective and safe treatments in induction and maintenance treatment for CD, and that both drugs had a similar efficacy and safety profile, compared with placebo.
Conclusions In the absence of direct comparative studies, both drugs can be considered alternatives with similar efficacy and safety for the treatment of adult patients with moderate to severe non-fistulizing CD.
No conflict of interest.
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