Adalimumab and Infliximab Are Equally Effective for Crohn's Disease in Patients Not Previously Treated With Anti-Tumor Necrosis Factor-alpha Agents

<p>BACKGROUND & AIMS: Infliximab (IFX) and adalimumab (ADA) are thought to have equal efficacy for the treatment of Crohn's disease (CD), although no direct comparison has been performed. We compared the effectiveness and safety of IFX and ADA in carefully matched cohorts.</p><p>METHODS: We performed a retrospective cohort study of 200 patients with CD (100 treated with IFX and 100 treated with ADA, starting in 2006 or later) who had not received anti-tumor necrosis factor alpha agents previously; the patients were identified from databases of 6 hospitals in The Netherlands. The groups were matched carefully for indication, duration of disease, age, and Montreal classification. The primary end point was the steroid-free clinical response, defined by a combination of multiple clinical parameters, after 1 year.</p><p>RESULTS: Of the total patient population, 63.5% and 45% had a clinical response after 1 and 2 years, respectively. There were no significant differences between treatment groups: at 1 and 2 years, 62% and 41% of those receiving ADA vs 65% and 49% of those receiving IFX had responses, respectively. Kaplan-Meier curves showed identical decreases in response rates over time. Combining IFX or ADA with immunomodulator therapy was associated with a higher clinical response than monotherapy, although this was only significant among patients who received IFX (P = .03). There were no differences in numbers of side effects or opportunistic infections.</p><p>CONCLUSIONS: The effectiveness of ADA or IFX treatment in anti-tumor necrosis factor alpha-naive patients with CD is comparable after 1 and 2 years of follow-up evaluation. The efficacies of IFX and ADA each seem to increase when given with immunomodulator therapy, although only significantly for IFX.</p>

Avaliação dos níveis séricos das vitaminas A, E, C e B2, de carotenóides e zinco, em idosos hospitalizados Assessment of vitamin A, E, C and B2, carotenoid and zinc serum levels in elderly hospital patients

Foram verificados os níveis séricos de zinco, carotenóides e vitaminas A, E, C, B2 em todos os idosos (n = 202) internados nas diversas enfermarias do hospital estudado, no período de fevereiro de 1986 a outubro de 1988. Foram estudados 130 homens e 72 mulheres que apresentaram média de idade de 67,8 anos, com variação entre 60 a 88. A percentagem de níveis séricos deficitários foi de 59,5 para o zinco, 56,5% para a vitamina C, 34,5% para a vitamina B2, 26% para a vitamina E, 13,2% para a vitamina A e 6,8% para os carotenóides. Os idosos portadores de leucoses, magaesôfogo, doença pulmonar obstrutiva crônica e insuficiência cardíaca congestiva constituíram-se no grupo de pacientes com grande prevalência de estado deficitário de zinco e das vitaminas estudadas, resultados que mostram a importância de se investigar as deficiências desses micronutrientes e dão subsídios para a abordagem terapêutica mais racional do paciente idoso internado.<br>Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients