S1801 Real-World Comparison of Infliximab and Adalimumab in Achieving Biomarker-Based Remission in Ulcerative Colitis

Introduction: Ulcerative colitis (UC) is a chronic inflammatory condition that significantly impairs quality of life. Biologic therapies such as Infliximab and Adalimumab, which target tumor necrosis factor alpha (TNF-α), have shown efficacy in controlling inflammation. Limited data exists that compares their efficacy in achieving biomarker-based remission. This study uses real-world data to provide a comprehensive comparison of Infliximab and Adalimumab in remission induction in UC. Methods: We conducted a retrospective cohort study using TriNetX data from 93 healthcare organizations. A total of 7,084 adult patients (≥18 years) with UC treated with Infliximab or Adalimumab between 2018 and 2023 were initially identified. Propensity score matching was performed to balance age, sex, race/ethnicity, disease severity, and comorbidities, resulting in 2,647 matched UC patients per treatment group (total n = 5,294). The primary outcome was biomarker-based remission, defined as serum C-reactive protein (CRP) ≤5 mg/L or fecal calprotectin ≤150 µg/g, and assessed at 6 months, 1 year, 3 years, and 5 years. Induction of remission rates and Kaplan-Meier survival analyses were reported for the UC cohort. Results: Infliximab demonstrated consistently higher remission rates than Adalimumab across all time points (P < 0.001). At 6 months, remission was achieved more frequently with Infliximab in UC (35.3% vs 25.4%). This pattern was held at 1 year (46.3% vs 37.1%), 3 years (61.9% vs 55.0%), and 5 years (65.9% vs 60.0%). Hazard ratios (HR) were directionally standardized to reflect Infliximab over Adalimumab (Infliximab/Adalimumab). Therefore, HR >1 indicates faster remission with Infliximab. Infliximab was associated with a significantly shorter time to remission across all time points in UC (all HRs >1, P < 0.001). Median time to remission was also consistently shorter with Infliximab compared to Adalimumab across the UC group. This supports the hazard ratio findings and further shows a faster induction of remission with Infliximab. Conclusion: Infliximab achieves more frequent and faster remission rates for UC at all time points. This may help guide biologic therapy selection and early treatment decisions in UC.