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. Dr. Hanauer 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

About Rob Hill

In 1994, Rob was a fit, healthy 23-year-old, an amateur runner and athlete. Until that time, he had never really been sick. He didn’t even have a regular doctor. When the illness started, it progressed rapidly. Daily diarrhea. Sustained stomach cramps. The diagnosis was Crohn’s disease, an inflammatory condition of the digestive tract. It got worse, and his weight plummeted from 185 to 105 pounds. After a year and a half, it became clear that his large intestine, his colon, needed to be removed. Rob decided he had to do something about it. The Seven Summits campaign, which we call “No Guts Know Glory” grew from Rob’s love of sport, adventure and the outdoors. By taking it to the extreme, and on a global basis, Rob hopes to show people everywhere that having these diseases or having an ostomy, like Rob does, shouldn’t stop you from leading a full life. You may not be able to climb mountains, but there are so many other things you can do. To further this goal, Rob started the Intestinal Disease Education and Awareness Society (IDEAS), from his home base in Vancouver, British Columbia.

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