Donate

Pros and Cons of Combination Therapy for IBD

Home»Health»Intestinal Disease»Crohns»Pros and Cons of Combination Therapy for IBD

Pros and Cons of Combination Therapy for IBD

Should patients with (IBD) receive combination therapy or monotherapy to treat their disease? Two experts debated both sides of this controversial issue at the Crohn’s & ’s Advances in Inflammatory Bowel Diseases meeting, held last December.

“The pendulum has swung back and forth over the years as to whether the risk–benefit analysis favors combination [treatment] or monotherapy,” said one expert, , MD, professor of medicine and clinical pharmacology, and chief of the Section of and Nutrition at the University of . “We still haven’t settled on one position.”

emphasized that the bulk of evidence points to the superiority of combining an with an anti- () in inducing remission in patients with Crohn’s disease (CD) compared with an anti- alone. said findings from SONIC (Study of Biologic and Immunomodulator Naive Patients in Crohn’s Disease) provide the most compelling data in favor of combination induction treatment. Results from that randomized, double-blind, controlled study showed that remission rates among patients with CD were significantly higher at 50 weeks in subjects who received combination induction and maintenance treatment with infliximab than in those who received either drug alone (Colombel JF et al. N Engl J Med 2010;362:1383-1395).

But not all data support combination treatment over monotherapy for maintenance of remission, Dr. Hanauer noted. A 2007 study found no significant differences in relapse rates between CD patients who continued with combination treatment and those who discontinued concomitant immunosuppressants, including azathioprine and methotrexate (Van Assche G et al.Gastroenterology 2008;134:1861-1868). Approximately half of all patients experienced flares of their disease within six months of initial infliximab treatment.

In a separate study, researchers found CD patients in remission after combination induction treatment had a 59% chance of relapsing within 24 months of discontinuing azathioprine (Oussalah A et al. Am J Gastroenterol 2010;105:1142-1149). Those investigators concluded that “azathioprine withdrawal is associated with a high risk for relapse in patients with a duration of combination therapy of less than 27 months and/or the presence of biological inflammation.”

Dr. Hanauer noted that “immunomodulators seem to reduce the risk for immunogenicity and antibody development, both of which lower serum drug levels and ultimately hamper the efficacy of drug treatment.”


Gastroenterology & Endoscopy News
Pros and Cons of Combination Therapy for IBD
Gastroenterology & Endoscopy News
Should patients with inflammatory bowel disease (IBD) receive combination therapy or monotherapy to treat their disease? Two experts debated both sides of this controversial issue at the Crohn’s & Colitis Foundation’s Advances in Inflammatory Bowel

You must be logged in to post a comment Login

No Guts Know Glory

IDEAS Kids

IDEAS Kids

IBD Adventures