Comparable remission and health care use in real-world inflammatory bowel disease patients initiating originator biologics vs biosimilars

doi:10.3748/wjg.v32.i9.114580

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Mar 7, 2026 (publication date) through Mar 2, 2026

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Mar 7, 2026; 32(9): 114580
Published online Mar 7, 2026. doi: 10.3748/wjg.v32.i9.114580

Table 1 Baseline characteristics of biologic users, Canadian IBD Research Consortium cohort, Canada, 2018-2024, n (%)

	Originator, n = 66	Biosimilar, n = 192	Overall, n = 258
Biologic at enrollment
Adalimumab	28 (42.4)	35 (18.2)	63 (24.4)
Infliximab	38 (57.6)	157 (81.8)	195 (75.6)
Age in years at IBD diagnosis, median (IQR)	27.1 (19.0, 38.6)	26.7 (20.1, 37.1)	26.9 (19.9, 37.7)
Age in years at biologic initiation, median (IQR)	37.3 (27.4, 55.3)	38.7 (28.5, 52.3)	38.3 (28.0, 52.7)
Sex
Female	36 (54.5)	96 (50.0)	132 (51.2)
Male	30 (45.5)	96 (50.0)	126 (48.8)
Race/ethnicity
Caucasian	56 (84.8)	158 (82.3)	214 (82.9)
Others	8 (12.1)	30 (15.6)	38 (14.7)
Missing	2 (3.0)	4 (2.1)	6 (2.3)
Education
Secondary or less	19 (28.8)	55 (28.6)	74 (28.7)
College or university	43 (65.2)	134 (69.8)	177 (68.6)
Missing	4 (6.1)	3 (1.6)	7 (2.7)
IBD diagnosis
CD	44 (66.7)	118 (61.5)	162 (62.8)
UC	22 (33.3)	74 (38.5)	96 (37.2)
Moderate or high disease activity¹	26 (39.4)	77 (40.1)	103 (39.9)
At least one co-morbidity²	24 (36.4)	68 (35.4)	92 (35.7)
Smoking status at enrollment
Current smoker	6 (9.1)	18 (9.4)	24 (9.3)
Ex-smoker	16 (24.2)	48 (25.0)	64 (24.8)
Never smoker	44 (66.7)	126 (65.6)	170 (65.9)
BMI (mean ± SD)	25.8 (5.4)	25.8 (5.8)	25.8 (5.7)
Site
HHSC, Ontario	35 (53.0)	32 (16.7)	67 (26.0)
McGill, Quebec	13 (19.7)	46 (24.0)	59 (22.9)
MSH, Ontario	2 (3.0)	6 (3.1)	8 (3.1)
PHCR, British Columbia	0 (0.0)	29 (15.1)	29 (11.2)
TBRHSC, Ontario	1 (1.5)	13 (6.8)	14 (5.4)
WRHA, Manitoba	15 (22.7)	66 (34.4)	81 (31.4)
IBD duration at enrollment in years, (mean ± SD)	9.6 ± 10.9	10.6 ± 10.9	10.3 ± 10.9
Drug use at enrollment or in the 12-month period before
Other biologics	15 (22.7)	19 (9.9)	34 (13.2)
Immunomodulators³	32 (48.5)	63 (32.8)	95 (36.8)
5-ASA	17 (25.7)	49 (25.5)	66 (25.6)
Corticosteroids	33 (50.0)	90 (46.9)	123 (47.7)

¹In Crohn’s disease, either a Harvey-Bradshaw Index > 8 or a Crohn's Disease Activity Index > 220; in ulcerative colitis, a Partial Mayo Score ≥ 5.

²Congestive heart failure, diabetes, hypertension, coronary artery disease, malignancies, renal failure.

³Methotrexate and azathioprine.

5-ASA: 5-aminosalicylates; CD: Crohn’s disease; HHSC: Hamilton Health Sciences Corporation; IBD: Inflammatory bowel disease; IQR: Interquartile range; McGill: McGill University Health Centre; MSH: Mount Sinai Hospital; PHCR: Providence Health Care Society/University of British Columbia; TBRHSC: Thunder Bay Regional Health Sciences Centre; UC: Ulcerative colitis; WRHA: Winnipeg Regional Health Authority; BMI: Body mass index.

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Table 2 Multivariate Cox regression model for first clinical remission during follow-up, Canadian IBD Research Consortium cohort, Canada, 2018-2024

Characteristic	Unadjusted HR (95%CI)	Adjusted HR (95%CI)
Biosimilar at enrollment	1.06 (0.70-1.60)	1.49 (0.96-2.32)
Female sex	0.96 (0.67-1.38)	0.96 (0.66-1.40)
Age at IBD diagnosis	0.99 (0.98-1.00)	0.99 (0.98-1.01)
IBD duration at biologic start	1.00 (0.98-1.02)	0.98 (0.96-1.00)
UC disease	0.50 (0.34-0.75)	0.35 (0.22-0.55)
Moderate or high disease activity¹	0.51 (0.35-0.74)	0.36 (0.23-0.54)
Previous use of biologic²	1.10 (0.66-1.84)	1.67 (0.93-2.99)
Corticosteroid use³	0.80 (0.55-1.16)	1.00 (0.68-1.59)
Immunomodulator use⁴	1.40 (0.97-2.02)	1.44 (0.97-2.13)
One or more comorbidity⁵	1.02 (0.71-1.48)	1.41 (0.93-2.14)

¹In Crohn’s disease, either a Harvey-Bradshaw Index > 8 or a Crohn's Disease Activity Index > 220; in ulcerative colitis, a Partial Mayo Score ≥ 5.

²Anytime before enrollment.

³Current or past 12 months before enrollment.

⁴Methotrexate and azathioprine.

⁵Congestive heart failure, diabetes, hypertension, coronary artery disease, malignancies, renal failure.

CI: Confidence interval; HR: Hazard ratio; IBD: Inflammatory bowel disease; UC: Ulcerative colitis.

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Citation: Moura CS, Etingin A, Lukusa L, Singh H, Narula N, Targownik LE, Leung Y, Zezos P, Polewiczowska-Nowak B, Afif W, Bernatsky S. Comparable remission and health care use in real-world inflammatory bowel disease patients initiating originator biologics vs biosimilars. World J Gastroenterol 2026; 32(9): 114580
URL: https://www.wjgnet.com/1007-9327/full/v32/i9/114580.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i9.114580