title: Combination therapy with infliximab and thiopurine compared to infliximab monotherapy in maintaining remission of postoperative Crohn's disease.
abstract: OBJECTIVE
  Infliximab is an efficacious agent used for the induction and maintenance of remission in Crohn's disease (CD), and recent studies suggested that it may also prevent the recurrence of this disease after surgery. The present study was performed to assess the efficacy and safety of infliximab in the postoperative setting, and to identify whether combination treatment with thiopurines had any additional beneficial effect as compared to mono-therapy.
  
  
  METHODS
  We performed a retrospective cohort study to compare the efficacy of infliximab mono-therapy and combination treatment with a thiopurine in preventing recurrence after surgery.
  
  
  RESULTS
  Forty-one patients who received infliximab as maintenance treatment following surgery from May 2002 to April 2010 were identified. Twenty-four were naive to infliximab, and 17 who underwent surgery during infliximab treatment were continued on it following surgery. The median follow-up period was 27 months (range 12-66 months). All patients continued infliximab as maintenance treatment, but 10 required dose intensification due to clinical recurrence. Kaplan-Meier analysis demonstrated that the use of concomitant thiopurine was correlated with the continuation of infliximab treatment at an 8-week interval (log-rank test p = 0.018). The rate of adverse event was 9.8% with no patient experiencing severe adverse reactions.
  
  
  CONCLUSIONS
  Infliximab appears to be safe and it prevented clinical recurrence after surgery. Concomitant thiopurine use predicted response toward continuation of therapy at an 8-week interval. Prospective controlled studies to assess the efficacy of combination treatment in the postoperative setting are warranted.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakuraba
authors.forename: Susumu
authors.initials: S
authors.lastname: Okamoto
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Matsuoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sato
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention; D013872:Thionucleosides / Q000627:therapeutic use*
chemical_list: D005765:Gastrointestinal Agents; D013872:Thionucleosides; D000069285:Infliximab