Among the many biologics used to treat adults with moderate-to-severe Crohn’s disease (CD), infliximab subcutaneous (SC) 120 mg every 2 weeks (Q2W) demonstrates the highest efficacy in clinical remission during maintenance treatment of 52 to 64 weeks’ duration, according to the results of a recent study presented at CCC 2025.

“While the therapeutic armamentarium for CD is rapidly expanding, direct evidence on comparative efficacy of various treatments is lacking,” said Dr Stefan Schreiber, director of the Clinic for Internal Medicine I at Kiel Campus of the University Hospital Schleswig-Holstein in Germany.

To address this, Schreiber and his team conducted a network meta-analysis (NMA) and assessed the comparative efficacy of licensed biologics, namely infliximab intravenous (IV) and SC, adalimumab SC, vedolizumab IV and SC, ustekinumab SC, and risankizumab SC.

Phase III randomized controlled trials (RCTs) were included, particularly those that examined biologics approved by the European Medicines Agency or the United States Food and Drug Administration as of 31 March 2023 for maintenance treatment of adult patients with moderate-to-severe CD. Eligible studies had follow-up periods of 52 to 64 weeks in patients who responded to induction treatment.

Each RCT was controlled with placebo or an active comparator. The investigators also included head-to-head studies that directly compared the efficacy of biologics in CD, including those with treat-through designs. Finally, they used a Bayesian NMA fixed-effect model to compare the rates of clinical remission following the maintenance treatment.

Only eight RCTs met the eligibility criteria and were included in the analysis. These studies were as follows: ACCENT I, LIBERTY-CD, CHARM, SEAVUE, GEMINI 2, VISIBLE 2, IM-UNITI, and FORTIFY. [Inflamm Bowel Dis 2024;30(Suppl 1):S7]

Both naive- and biologic- and/or Janus kinase inhibitor-exposed patients were enrolled in these studies, except for ACCENT-1 and SEAVUE which enrolled only antitumour necrosis factor- and biologic-naive patients, respectively.

Of the eight comparator arms, infliximab SC 120 mg Q2W had the highest likelihood for clinical remission when compared with placebo during the maintenance phase (odds ratio [OR], 3.52, 95 percent credible interval [CI], 2.18?5.65).

This was followed by adalimumab SC 40 mg Q2W (OR, 2.92, 95 percent CI, 1.90?4.47), ustekinumab SC 90 mg every 8 weeks (Q8W; OR, 2.79, 95 percent CI, 1.85?4.21), infliximab IV 5 mg/kg Q8W (OR, 2.55, 95 percent CI, 1.29?5.27), vedolizumab IV 300 mg Q8W (OR, 2.33, 95 percent CI, 1.43?3.86), risankizumab SC 180 mg Q8W (OR, 1.80, 95 percent CI, 1.15?2.84), vedolizumab SC 108 mg Q2W (OR, 1.76, 95 percent CI, 1.14?2.70), and risankizumab SC 360 mg Q8W (OR, 1.60, 95 percent CI, 1.00?2.52).

Moreover, treatment with infliximab SC 120 mg Q2W exhibited the highest surface under the cumulative ranking curve (SUCRA) values (0.887). This was followed by adalimumab SC 40 mg Q2W (SUCRA, 0.763), ustekinumab SC 90 mg Q8W (SUCRA, 0.718), infliximab IV 5 mg/kg Q8W (SUCRA, 0.630), vedolizumab IV 300 mg Q8W (SUCRA, 0.566), risankizumab SC 180 mg Q8W (SUCRA, 0.353), vedolizumab SC 108 mg Q2W (SUCRA, 0.327), risankizumab SC 360 mg Q8W (SUCRA, 0.252), and placebo (SUCRA, 0.005).

“CT-P13 [a biosimilar of infliximab] SC provides patients with a new opportunity for maintenance treatment of their disease,” said Schreiber.