Ashwin N Ananthakrishnan1, Andrew Cagan, Tianxi Cai, Vivian S Gainer, Stanley Y Shaw, Guergana Savova, Susanne Churchill, Elizabeth W Karlson, Isaac Kohane, Katherine P Liao, Shawn N Murphy. 1. *Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; †Harvard Medical School, Boston, Massachusetts; ‡Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; §Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts; ‖Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts; ¶Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts; **Children's Hospital Informatics Program, Boston Children's Hospital, Boston, Massachusetts; ††Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; ‡‡Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts; §§Children's Hospital Boston, Boston, Massachusetts; and ‖‖Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: The availability of monoclonal antibodies to tumor necrosis factor α has revolutionized management of Crohn's disease (CD) and ulcerative colitis. However, limited data exist regarding comparative effectiveness of these agents to inform clinical practice. METHODS: This study consisted of patients with CD or ulcerative colitis initiation either infliximab (IFX) or adalimumab (ADA) between 1998 and 2010. A validated likelihood of nonresponse classification score using frequency of narrative mentions of relevant symptoms in the electronic health record was applied to assess comparative effectiveness at 1 year. Inflammatory bowel disease-related surgery, hospitalization, and use of steroids were determined during this period. RESULTS: Our final cohort included 1060 new initiations of IFX (68% for CD) and 391 of ADA (79% for CD). In CD, the likelihood of nonresponse was higher in ADA than IFX (odds ratio, 1.62 and 95% CI, 1.21-2.17). Similar differences favoring efficacy of IFX were observed for the individual symptoms of diarrhea, pain, bleeding, and fatigue. However, there was no difference in inflammatory bowel disease-related surgery, hospitalizations, or prednisone use within 1 year after initiation of IFX or ADA in CD. There was no difference in narrative or codified outcomes between the 2 agents in ulcerative colitis. CONCLUSIONS: We identified a modestly higher likelihood of symptomatic nonresponse at 1 year for ADA compared with IFX in patients with CD. However, there were no differences in inflammatory bowel disease-related surgery or hospitalizations, suggesting these treatments are broadly comparable in effectiveness in routine clinical practice.
BACKGROUND: The availability of monoclonal antibodies to tumornecrosis factor α has revolutionized management of Crohn's disease (CD) and ulcerative colitis. However, limited data exist regarding comparative effectiveness of these agents to inform clinical practice. METHODS: This study consisted of patients with CD or ulcerative colitis initiation either infliximab (IFX) or adalimumab (ADA) between 1998 and 2010. A validated likelihood of nonresponse classification score using frequency of narrative mentions of relevant symptoms in the electronic health record was applied to assess comparative effectiveness at 1 year. Inflammatory bowel disease-related surgery, hospitalization, and use of steroids were determined during this period. RESULTS: Our final cohort included 1060 new initiations of IFX (68% for CD) and 391 of ADA (79% for CD). In CD, the likelihood of nonresponse was higher in ADA than IFX (odds ratio, 1.62 and 95% CI, 1.21-2.17). Similar differences favoring efficacy of IFX were observed for the individual symptoms of diarrhea, pain, bleeding, and fatigue. However, there was no difference in inflammatory bowel disease-related surgery, hospitalizations, or prednisone use within 1 year after initiation of IFX or ADA in CD. There was no difference in narrative or codified outcomes between the 2 agents in ulcerative colitis. CONCLUSIONS: We identified a modestly higher likelihood of symptomatic nonresponse at 1 year for ADA compared with IFX in patients with CD. However, there were no differences in inflammatory bowel disease-related surgery or hospitalizations, suggesting these treatments are broadly comparable in effectiveness in routine clinical practice.
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