Does adalimumab achieve higher rates of complete fistula closure at 24 weeks than certolizumab pegol in patients with perianal CD

What is known

- In CHARM, adalimumab produced complete fistula closure in ~30% at week 26 and 33% at week 56 versus 13% placebo. ^1–3 - Certolizumab pegol (PRECISE) showed ~30-31% fistula closure through week 26, similar to placebo (31%). ^1,3 - PRECISE-2 subgroup of induction responders showed no significant benefit of continued certolizumab (54%) vs placebo (43%, p=0.069). ^2,3

What is unknown / caveats

- No head-to-head adalimumab vs certolizumab trial in the retrieved evidence - Endpoints and timepoints differ (week 26/56, not 24); cross-trial comparison is confounded by different populations and definitions - Indirect cross-trial comparison cannot establish superiority of one agent over the other at any timepoint.

## References

1. Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P. Comparison of the Efficacy of the Various Treatment Modalities in the Management of Perianal Crohn's Fistula: A Review. Cureus. 2020;12(12):e11882. PMID: 33415035.

2. Steinhart AH, Panaccione R, Targownik L, Bressler B, Khanna R, Marshall JK, Afif W, Bernstein CN, Bitton A, Borgaonkar M, Chauhan U, Halloran B, Jones J, Kennedy E, Leontiadis GI, Loftus EV, Meddings J, Moayyedi P, Murthy S, Plamondon S, Rosenfeld G, Schwartz D, Seow CH, Williams C. Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn's Disease: The Toronto Consensus. J Can Assoc Gastroenterol. 2018;1(4):141-154. PMID: 31799497.

3. Adegbola SO, Pisani A, Sahnan K, Tozer P, Ellul P, Warusavitarne J. Medical and surgical management of perianal Crohn's disease. Ann Gastroenterol. 2018;31(2):129-139. PMID: 29507460.

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_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._