S1893 Adalimumab vs Infliximab: A 5-Year Real-World Comparison of Hospitalization Risks in Inflammatory Bowel Disease Patients

Introduction: Inflammatory bowel disease (IBD) is a chronic condition associated with frequent hospitalizations that impact patient quality of life and drive healthcare costs. Anti-TNF agents, including adalimumab and infliximab, are cornerstone therapies for IBD, but their comparative long-term effectiveness in reducing hospitalizations remains unclear. This study provides a 5-year real-world comparison of hospitalization risks between these agents. Methods: We conducted a retrospective cohort study using the TriNetX database, including IBD patients aged ≥18 years treated with adalimumab or infliximab. Propensity score matching yielded balanced cohorts of 28,912 patients each. Hospitalization rates were assessed at 6 months, 1 year, 3 years, and 5 years. Kaplan-Meier analysis evaluated hospitalization-free survival, and hazard ratios (HRs) while risk differences, risk ratios (RR), odds ratios (OR), and hazard ratios (HR) quantified between-group differences. Results: Adalimumab demonstrated consistently lower hospitalization rates compared to infliximab across all time points. Rates decreased from 6.61% vs 11.62% at 6 months to 14.7% vs 19.1% at 5 years (P < 0.001). KaplanMeier analysis showed higher hospitalization-free survival for adalimumab at 5 years (80.54%) compared to infliximab (76.19%; HR: 0.727, 95% CI: 0.699–0.757, P < 0.001). Conclusion: Our 5-year real-world analysis reveals that adalimumab reduces hospitalization risks more effectively than infliximab in IBD patients, providing actionable insights for long-term treatment strategies. Future research should explore the cost-effectiveness of adalimumab and refine treatment approaches for high-risk subgroups, including patients with comorbidities or on concurrent immunosuppressive therapies.