Which patients with inflammatory bowel disease should receive combination therapy?
Traditionally, patients with inflammatory bowel disease underwent 'step-up' therapy to induce a clinical remission. However, when step-up treatment is used, the more efficacious anti-TNF agents are reserved for patients unable to achieve remission with immune suppressants (IS). Several pivotal trials have demonstrated the superiority of early combination therapy of IS and anti-TNF to 'step-up' therapy and azathioprine or infliximab monotherapy. Concerns about treatment cost and adverse events of combination therapy have precluded widespread adoption of early combination therapy. Recent studies have demonstrated that combination treatment followed by withdrawal of IS or infliximab was not associated with an increased rate of relapse. Providers must include the benefits and risks of combination therapy in shared decision-making discussions with patients about to start treatment. Improved diagnostic and prognostic tests in the future are likely to help providers select the ideal patient for combination therapy.
Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland, 100 North Greene Street, LL Baltimore, MD 21201, USA.
Raymond K
RK
Cross
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D018579:Patient Selection; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
Crohn’s disease; TNF-α; biologic therapy; decision making; immune suppressive agents; inflammatory bowel disease; ulcerative colitis