In anti‑TNF-naive adults with moderate-to-severe UC, is infliximab or adalimumab preferred for induction
Out of scope for this tool. The focus of this literature tool is the surgical management of IBD. For medical management and drug dosing, please see ChatIBD.com.
indirect-comparison meta-analysis of anti-TNF-naïve moderate-to-severe ulcerative colitis found infliximab more efficacious than adalimumab at 8 weeks for clinical remission, response, and mucosal healing 1. however, this superiority derives from indirect (not head-to-head) comparison, and reviewers judged the evidence insufficient to change clinical practice 2. 1–3
What is known: - In anti-TNF-naïve patients, indirect comparison found infliximab superior to adalimumab for 8-week clinical remission, response, and mucosal healing. 1 - A narrative review notes adalimumab induces remission but appears less potent than infliximab. 3 - Route and dosing convenience (subcutaneous every 2 weeks vs intravenous) may drive the choice between agents based on patient preference. 1,2
What is unknown / caveats: - Indirect meta-analysis favors infliximab, but reviewers say evidence is insufficient to change practice - Comparison is indirect, not a head-to-head randomized trial - 8-week superiority may not be sustained to 52 weeks - Choice often governed by cost, insurance, route, and patient preference - Whether infliximab's early advantage persists long-term is unconfirmed, and no direct comparative trial exists.
## References
1. Thorlund K, Druyts E, Mills EJ, Fedorak RN, Marshall JK. Adalimumab versus infliximab for the treatment of moderate to severe ulcerative colitis in adult patients naïve to anti-TNF therapy: an indirect treatment comparison meta-analysis. J Crohns Colitis. 2014;8:571-81. PMID: 24491514.
2. Fausel R, Afzali A. Biologics in the management of ulcerative colitis - comparative safety and efficacy of TNF-α antagonists. Ther Clin Risk Manag. 2015. PMID: 25609972.
3. Hoentjen F, Sakuraba A, Hanauer S. Update on the management of ulcerative colitis. Curr Gastroenterol Rep. 2011;13:475-85. PMID: 21789495.
For educational use only, not a substitute for clinical judgement or medical advice. Consult qualified clinicians for diagnosis and treatment decisions. This tool may contain errors; use the flag button below to report inaccurate or harmful content.
---
_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._
Reviewer notes