Adalimumab and infliximab are equally efficient in achieving sustained remission in ulcerative colitis but infliximab is superior in severe disease—a retrospective observational study

Infliximab and adalimumab are first-line biological therapies in ulcerative colitis. Meta-analyses of randomized control trials indicate infliximab being more effective but observational studies indicate similar effect. Our aim was to compare short- and long-term efficacy of infliximab and adalimumab in bio-naive patients with ulcerative colitis in a real-world setting during the modern era of therapeutic drug monitoring and dose optimization. We performed a retrospective multicentre observational cohort study. Patients initiating infliximab or adalimumab at four out-patient IBD-clinics between 2018 and 2022 were included. 105 patients were treated with infliximab and 166 with adalimumab. Steroid-free clinical remission at 12 months was reached in 43% (n = 37) of patients with infliximab and 35% (n = 55) with adalimumab (aOR: 1.41 (0.81–2.45), p = 0.22). Clinical remission at 3 months was more common with infliximab than adalimumab (68 vs. 57%, aOR 1.83 (1.07–3.14), p n = 32) vs. 46% (n = 26) (p Adalimumab and infliximab achieved similar rates of long-term remission in bio-naive patients with ulcerative colitis. However, infliximab was superior in induction of remission and in patients with severe disease.