Adalimumab for Adult Patients with Crohn’s Disease: A Review of Clinical Effectiveness

Key Message

Seven systematic reviews (two with meta-analyses and five with network meta-analyses) and four relevant head-to-head primary studies contained within the systematic reviews were identified regarding the clinical effectiveness of adalimumab compared to infliximab or vedolizumab in adults with Crohn’s disease. The seven systematic reviews were generally well-conducted, but there were methodological limitations in their included primary studies which provided low to moderate strength evidence. 

The identified literature revealed mixed conclusions regarding the clinical effectiveness of adalimumab compared to infliximab or vedolizumab in adults with Crohn’s disease. Specifically, in two primary studies and three network meta-analyses comparing adalimumab to infliximab, no treatment was favoured in effectiveness (e.g., disease recurrence) and safety (e.g., hospitalization due to serious infection) outcomes. However, significant findings from two primary studies and one network meta-analysis favoured the use of infliximab in terms of risk of abdominal surgery, early treatment termination, or induction of clinical response, while findings from one network meta-analysis favoured the use of adalimumab in terms of withdrawals due to adverse events. 

In three network meta-analyses comparing adalimumab to vedolizumab, no treatment was favoured in effectiveness (e.g., induction of clinical remission) and safety (e.g., withdrawals due to adverse events) outcomes. However, findings from one of the aforementioned network meta-analyses favoured adalimumab over vedolizumab in the maintenance of clinical remission.

The limitations of the included primary literature (e.g., lack of blinding of participants and health care professionals, heterogeneity of outcome measures, variation in prior abdominal surgery history, inconsistencies in study findings) should be considered when interpreting these results. Additionally, since two network meta-analyses involved studies of post-surgical patients, the findings from this report may not be generalizable to all patients living with Crohn’s disease.