Which is best Biologic Therapy in Moderate to Severe Crohn's Disease?

Infliximab and adalimumab appear to be most effective as first-line agents for patients with moderate-to-severe Crohn's disease (CD), according to a new systematic review of biologic therapies published in the journal Alimentary Pharmacology and Therapeutics.

Infliximab neutralizes the biological activity of TNF-α and reduces the inflammation caused by it. Adalimumab binds to TNF-alpha and blocks its interaction with the p55 and p75 cell surface TNF receptors.

S.Singh conducted a study to assess comparative efficacy and safety of first‐line (biologic‐naïve) and second‐line (prior exposure to anti-tumor necrosis factor [TNF]‐α) agents) biologic therapy for moderate‐severe CD, through a systematic review and network meta‐analysis, and appraised quality of evidence (QoE) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Researchers identified randomized controlled trials (RCTs) in adults with moderate‐severe CD treated with approved anti‐TNF agents, anti‐integrin agents, and anti‐IL12/23 agents, first‐line or second‐line, and compared with placebo or another active agent. Efficacy and safety outcomes included induction and maintenance of clinical remission, and serious adverse events/infections, respectively. The treatments were ranked using surface under the cumulative ranking (SUCRA) probabilities, with higher scores representing higher ranking for efficacy and safety outcomes.

Key findings of the study:

• In biologic‐naive patients, infliximab (SUCRA,0.93) and adalimumab (SUCRA,0.75) were ranked highest for induction of clinical remission (moderate QoE).


• In patients with prior anti‐TNF exposure, adalimumab (SUCRA, 0.91; low QoE, in patients with prior response or intolerance to anti‐TNF agents) and ustekinumab (SUCRA, 0.71) were ranked highest for induction of clinical remission.


• In patients with response to induction therapy, adalimumab (SUCRA, 0.97) and infliximab (SUCRA, 0.68) were ranked highest for maintenance of remission. Ustekinumab had the lowest risk of serious adverse events (SUCRA, 0.72) and infection (SUCRA, 0.71; along with infliximab, SUCRA, 0.83) in maintenance trials.

The study concluded that infliximab or adalimumab may be preferred first‐line agents, and ustekinumab a preferred second‐line agent, for induction of remission in patients with moderate to severe CD.

Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of the digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

For more information log on to https://doi.org/10.1111/apt.14852