Comparing adalimumab and infliximab in the prevention of postoperative recurrence of Crohn’s disease: a systematic review and meta-analysis

Authors Manesh Kumar Gangwani, Mohamad Nawras, Muhammad Aziz, Anooja Rani, Fnu Priyanka, Dushyant Singh Dahiya, Zohaib Ahmed, Amir Humza Sohail, Rahul Karna, Wade Lee-Smith, Abdallah Kobeissy, Yaseen Alastal.


Background Crohn’s disease is a relapsing disease that often requires operative management. Prevention of postoperative recurrence (POR) is critical to maintain remissions. Biologic agents have proven to be most successful in remission maintenance. We made a direct head-to-head comparison of the 2 anti-tumor necrosis factor agents, infliximab (IFX) and adalimumab (ADA), to compare endoscopic and clinical POR of Crohn’s disease.

Methods We conducted a comprehensive literature search in 7 databases, including Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCIKorean Journal Index, SciELO, and Global Index Medicus. Odds ratios (OR) were calculated with 95% confidence intervals (CI) and P-values (<0.05 considered significant). We evaluated the total rates of endoscopic recurrence, endoscopic recurrence at 1 year, and clinical recurrence rates of IFX and ADA in a direct head-to-head comparison.

Results The search strategy yielded a total of 393 articles. Three studies with a total of 268 participants were included. Our meta-analysis showed no statistically significant difference in total endoscopic recurrence rate between ADA and IFX (27.1% vs. 32.3%, OR 0.696, 95%CI 0.403- 1.201; P=0.193; I2=0%). Nor was there any significant difference between the drugs in endoscopic recurrence rate at 1 year (OR 0.799, 95%CI 0.329-1.940; P=0.620) or clinical recurrence rate (OR 0.477, 95%CI 0.477-1.712; P=0.755).

Conclusions ADA and IFX show comparable efficacy in preventing POR endoscopically and clinically. The clinical decision should be based on cost, side-effects, tolerability, and patient preferences. Additional studies, particularly randomized controlled trials, are needed to determine generalizability.

Keywords Postoperative recurrence, Crohn’s disease, adalimumab, infliximab, biologics

Ann Gastroenterol 2023; 36 (3): 293-299

Original Articles