In patients with de novo CD of the pouch, does infliximab provide superior remission rates compared with adalimumab

What is known

- Meta-analysis of 313 patients (194 infliximab, 119 adalimumab) found no difference in remission between infliximab and adalimumab. ^1,2 - Pooled anti-TNF remission was ~50% short-term and ~52% long-term, with CD-like pouch phenotypes responding better than refractory pouchitis/CARP. ^2–4 - The only adalimumab RCT in chronic pouchitis (13 patients) was underpowered and showed no benefit over placebo; infliximab evidence rests on case series. ^1,4,5

What is unknown / caveats

- No direct head-to-head infliximab vs adalimumab trial in pouch CD - Most data pool refractory pouchitis with CD-like pouch rather than isolating de novo CD - Evidence is retrospective case series plus underpowered adalimumab RCT - Retrieved data pool anti-TNF agents and mixed phenotypes, so a true de novo pouch CD comparison cannot be isolated.

## References

1. Lusetti F, Martins Helfenberger CA, Kurtz de Mello M, Queiroz NSF. Pouchitis unveiled: exploring clinical features, diagnosis, and cutting-edge treatments. Ther Adv Gastroenterol. 2025;18:17562848251316412. PMID: 39877662.

2. Weber AT, Lichtenstein GR. Evidence-Based Approach to Chronic Antibiotic Refractory Pouchitis: A Review. Dis Colon Rectum. 2024;67:S99-s105. PMID: 38363696.

3. Shen B, Kochhar GS, Rubin DT, Kane SV, Navaneethan U, Bernstein CN, Cross RK, Sugita A, Schairer J, Kiran RP, Fleshner P, McCormick JT, D'Hoore A, Shah SA, Farraye FA, Kariv R, Liu X, Rosh J, Chang S, Scherl E, Schwartz DA, Kotze PG, Bruining DH, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, Picoraro JA, Vermeire S, Sandborn WJ, Silverberg MS, Pardi DS. Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol. 2022;7:69-95. PMID: 34774224.

4. Donet JA, Rieder F, Charabaty A. #MondayNightIBD: Management of Chronic #Pouchitis. Crohns Colitis 360. 2020;2:otaa071. PMID: 36777755.

5. Chen SL, Faye AS, Chang S. Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment. Curr Treat Options Gastroenterol. 2022;20:564-581. PMID: 36844648.

For educational use only, not a substitute for clinical judgement or medical advice. Consult qualified clinicians for diagnosis and treatment decisions. This tool may contain errors; use the flag button below to report inaccurate or harmful content.

---

_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._