They both have roughly the same target, but Adalimumab is a more recent, technologically superior in every way, design. I'm frankly not 100% sure why any doctor would want to start someone on Infliximab in 2024 if Adalimumab was also available. I think the kind of doctor who does this is the kind of doctor who hasn't caught wind of the fact that early treatment with the best biologics leads to better patient outcomes (this is not the first paper that suggests this, it's a trend in clinical research that dates back at least 15 years). More traditionally, Infliximab was given first, and patients who failed that treatment were then "ramped up" to the equivalent but superior Adalimumab.
Nowadays the state of the art is to start with Adalimumab right off the bat, or even better, one of the newer biologics: either an integrin targeting one like Natalizumab or Vedolizumab (I admit to not being as up to date on this therapeutic avenue as I am on the others), or an IL23/IL12 targeting one like Ustekinumab (although the latter has already been obsoleted by the more p19-selective Risankizumab).
My gastro says he simply sees better results on infliximab than he does on adalimumab across all his patients, so he tends to start people on the former first. I think the fact that it's an infusion versus a shot does make a difference. AFAIK very few of his patients end up failing infliximab and switching to adalimumab, other than the ones who don't respond to TNFis period.
(Worth noting here that I actually was on twice-monthly adalimumab prior to getting a Crohn's DX, so I'm definitely one of those people for whom infliximab is a better choice. The adalimumab helped with spondylitis pain to an extent, but GI imaging at the time still came back definitively Crohn-y!)
My doctor put me on low-dose MTX for this exact reason—here's hoping I never start to develop infliximab antibodies...
Regarding the price, I would also have to assume they're comparing generic v generic (even though generic adalimumab wasn't available in the US until this year!), so I wonder if the reason they're saying infliximab is more expensive is because of the associated nursing labor/infusion clinic/IV supply costs. I only paid five bucks for my meds at the last infusion, but had to pay $160 for them to infuse it in me!
Also, side note, the fact that a name-brand Humira pen "only" cost the NHS £400 in the UK (and likely cost even less for patients) is blowing my mind. They retail for about $3500 a pop here :(
All that said, it's not a massive cheap free-for-all on medication - in the UK we've still got hospital/NHS trust budgets which have been iteratively slashed by a decade of successively worse Conservative governments, so generally the inclination is for the NHS to prescribe the (much) cheaper generics.
That said, our healthcare providers get very creative with pricing, so I don't know how Adalimumab compares. It's never been suggested to me.
> anti-TNF drugs, such as adalimumab, work similarly to infliximab and are significantly cheaper, more research is needed to establish whether they’re clinically effective
Adalimumab has been extensively tested and has been prescribed in the UK for at least 9 years - as that's how long I've been on it. The NHS wouldn't be prescribing it if it wasn't clinically effective.
Both medications are monoclonal antibodies for TNF-alpha, but are slightly different in formulation. Infliximab is a chimeric monoclonal antibody derived from a mouse/human cell lineage, whereas Adalimumab is derived solely from human sources.
My understanding (from the consultants at the research hospital where I am a Crohn's patient) is that Adalimumab is a) more expensive than Infliximab and b) less likely to trigger the patient to develop an immune response after a long prescription period, as the chimeric cell lineage can be recognised by the immune system as "foreign" after a while. I'm not a clinician so I can't really speak to the correctness of this statement, but anecdotally that's what I have been told by my consultant.
I am not sure that Infliximab is more expensive either. From what I understood at the time of my prescription, Adalimumab (Humira) was the more expensive drug, although prices have dropped significantly since then.
We got a generic Adalimumab formulation on the market in the UK about 3-4 years ago - until then, we were using AbbVie's Humira which I believe cost the NHS about £400/pen at the time. As I understand it, Infliximab is cheaper than this - although the generic Adalimumabs are also cheaper (~£80/pen IIRC).