S1804 Comparing Infliximab and Adalimumab for Biomarker-Based Remission in Crohn’s Disease: Insights From Real-World Data

Introduction: Infliximab and adalimumab are cornerstone therapies for Crohn’s disease (CD), yet direct comparisons of their efficacy in achieving biomarker-based remission are limited. With the use of the TriNetX database, one of the largest and most diverse real-world cohorts to date, this study evaluates remission induction outcomes for these biologic agents, offering insights into their roles in CD management. Methods: We conducted a retrospective cohort study using TriNetX data from 93 healthcare organizations. A total of 16,291 adult patients (≥18 years) with CD 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 6,516 matched CD patients per treatment group (total n = 13,032). 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 CD 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 CD (38.5% vs 28.3%). This pattern was held at 1 year (49.8% vs 42.6%), 3 years (66.1% vs 62.7%), and 5 years (71.2% vs 68.5%). 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 CD (all HRs >1, P < 0.001). Median time to remission was also consistently shorter with infliximab compared to adalimumab across the CD 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 CD at all time points. This may help guide biologic therapy selection and early treatment decisions in CD.