Abstract
BACKGROUND AND AIMS: Anti-tumor necrosis factor therapy has been a mainstay of medical management of perianal Crohn's disease (CD). This systematic review and meta-analysis aimed to compare the efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of perianal fistulizing CD. METHODS: We searched PubMed, Embase, and Web of Science databases for studies that compared the efficacy of ADA with IFX for treatment of patients with perianal fistulizing CD. Single-arm studies were excluded. The primary outcomes were perianal CD healing evaluated clinically or radiologically. RESULTS: Six observational studies with a total of 590 patients with perianal CD (216 received ADA and 374 received IFX) were included. Overall, perianal CD healing was comparable between ADA and IFX (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.76-1.06, P = .20). Subgroup analysis based on the healing assessment method showed no significant difference between ADA and IFX whether assessment was performed clinically (RR 0.90, 95% CI 0.67-1.21, P = .49) or radiologically (RR 0.91, 95% CI 0.74-1.13, P = .40). CONCLUSION: In this systematic review and meta-analysis, ADA was not inferior to IFX in effectiveness for the treatment of perianal CD. Head-to-head prospective and randomized controlled studies comparing ADA and IFX are necessary to validate the findings of this study.