Influencing factors on the persistence of infliximab and adalimumab
treatment in Crohn's disease
Abstract
Aim The aim of the study was to define and compare persistence of
infliximab and adalimumab according to the treatment line. The secondary
objectives were to identify factors that influence persistence. Methods
We performed an observational, retrospective, single-center study with
adult patients diagnosed with Crohn’s disease between November 2001 and
May 2020. A total of 309 patients were included. Survival analysis and
Cox regression were used. The following factors were studied: gender,
body mass index, use of concomitant immunosuppressants, time from
diagnosis to the beginning of the biological, trough drug levels on
target, year where the anti-TNFα began and initial patient
characteristics at the beginning of the treatment. Results The median
persistence associated with the first-line of anti-TNFα treatment showed
a statistically significant difference with respect to the second-line
(7.0 vs 5.2, p= 0.0082). Differences between infliximab and adalimumab
were not statistically significant (7.8 vs 6.5, p= 0.91). The
multivariate Cox analysis shows that only drug concentrations on target
and year of initiation of anti-TNFα were associated with higher
persistence in first-line treatment (p= 0.04). In the second-line the
difference between the infliximab and adalimumab subgroups was not
statistically significant (5.1 vs 5.2, p= 0.5). Only the year of
initiation of treatment showed an influence on persistence. Conclusion
Persistence was greater in the first-line. No differences in persistence
were observed between infliximab and adalimumab. The most important
influencing factors were the year of initiation of treatment and target
drug concentrations.