Study Shows Patients With Ulcerative Colitis Prefer Adalimumab to Infliximab

A study of Japanese patients with ulcerative colitis (UC) who were naïve to anti—tumor necrosis factor (TNF) treatment found that patients preferred adalimumab to infliximab, but the researchers also reported no differences in the efficacy of the 2 treatments. The study was conducted by Tsutomu Mizoshita, MD, PhD, and colleagues, and was published in Medicine (Baltimore) in August 2017.

During regular outpatient visits or during hospital stays, 25 patients with UC who were naïve to anti-TNF therapy were asked to evaluate, via questionnaire, whether they preferred to receive infliximab or adalimumab, and to provide reasons that contributed to their choice of therapy.

The researchers used the Mayo score and endoscopic activity index (EAI) as a measure of disease activity in the patients, before they initiated the treatment of their preference and at weeks 14 and 54. The primary difference between the 2 treatments is the mode (intravenous versus subcutaneous) and interval (every 2 months versus every 2 weeks) of administration. There is no difference in cost to the patient between infliximab and adalimumab in Japan, as healthcare is publicly funded.

Of the 25 patients who answered the questionnaire, 40% (n = 10) preferred infliximab, while 60% (n = 15) preferred adalimumab.

Patients who favored infliximab considered the following factors:

• Fear of syringes (70%)

• Scientific evidence for efficacy (40%)
• Duration approved for use (30%)

Patients who favored adalimumab considered the following factors:

• Ease of administration (66.7%)
• Time required for therapy (66.7%)
• Time intervals between medication (46.7%)
• Duration approved for use (13.3%)

There were no statistical differences in remission induction and maintenance between the infliximab and adalimumab groups with regard to response, remission, mucosal healing, steroid-free, or steroid-free remission rates at weeks 14 and 54. The efficacy of adalimumab in remission induction and maintenance was equivalent to that of infliximab in patients with UC who were naïve to anti-TNF therapy in this prospective study, but more patients preferred adalimumab.

The researchers believe their study is the first to show that there were no differences between infliximab and adalimumab with regard to response, remission, mucosal healing, steroid-free, and steroid-free remission rates in Japanese patients with UC who were naïve to anti-TNF therapy. It is also the first head-to-head comparison trial of the efficacy of remission induction and maintenance between infliximab and adalimumab in this population. The investigators suggest that further studies be conducted in larger populations to clarify which anti-TNF therapy is preferred by patients with UC.