Does everyone with inflammatory bowel disease need to be treated with combination therapy?
This article describes the evolution of combination therapy in inflammatory bowel disease and how to determine when combination may not be necessary.



The combination of an immunosuppressive agent with an antibody to tumor necrosis factor has proven to be more effective than monotherapy with either an immunosuppressive agent or an antibody to tumor necrosis factor alone. The emergence of therapeutic drug monitoring has identified the importance of maintaining adequate circulating drug levels and suppressing antibody formation to the biological agent. The concomitant use of an immunosuppressive agent can help effect this. Although this may be optimal therapy in moderately ill patients. I review why there still remains a role for using monotherapy with immunosuppressive agents, as well as consideration of therapy withdrawal.



Although combination therapy is the treatment of choice in persons with moderate to severe disease or who have lost response to biological monotherapy, there remains a role for monotherapy with immunosuppressive agents. Though the newer biological therapies are mostly not used in combination, this may be a future approach considering their response rates are also correlated with higher drug levels. Many persons with inflammatory bowel disease can remain well on an immunosuppressive agent alone and some can even maintain a longstanding remission off all therapy.
University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
Charles N
CN
Bernstein
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha