Combination therapy of infliximab and azathioprine reduces disease progression in Crohnʼs disease

Din, Shahida; Cochrane, Clint; Noble, Colin; Satsangi, Jack; Arnott, Ian

doi:10.1002/ibd.20260

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…[29] multicenter retrospective review of infliximab infusions reported that the cumulative proportion of 447 patients continuing infliximab therapy at 2, 4, and 5 years was 73%, 58%, and 54%, respectively, but no efficacy outcomes were reported. Finally Din et al [8] reported impact on disease progression of either infliximab or azathioprine in a casecontrol study of 146 patients with 3-4 years of follow-up. None of the 16 patients receiving infliximab and azathioprine had disease progression to a more serious behavior type.…”

Section: Discussionmentioning

confidence: 96%

“…Data from clinical trials and retrospective studies have identified concomitant immunomodulator (IMM) use, e.g., azathioprine or 6-mercaptopurine (6-MP), as a predictor of early response and lower relapse rates [6][7][8][9][10][11][12]. This may be due to its ability to reduce the immunogenicity of these monoclonal antibodies, or some synergistic effect.…”

Section: Introductionmentioning

confidence: 96%

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Impact of Concomitant Immunomodulator Use on Long-Term Outcomes in Patients Receiving Scheduled Maintenance Infliximab

et al. 2009

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The long-term benefits of combining scheduled infliximab with concomitant immunomodulators [azathioprine or 6-mercaptopurine (6-MP)] in patients with Crohn's disease are unclear. Historical cohort followed for 5 years after initiation of infliximab for active Crohn's disease. Data were available on 123 patients who received scheduled maintenance infliximab infusions, for up to 5 years after initiation of infliximab. Clinical remission rates in the entire cohort were 73% (82/113) at 1 year, 65% (65/100) at 2 years, and 58% (21/36) at 5 years. Remission rates with maintenance infliximab were significantly improved in those receiving concomitant immunomodulators at 1 year (86% versus 68%, P = 0.03), but not at 2 years (80% versus 72%, P = 0.4). In a multivariate logistic regression model, concomitant immunomodulator use was not associated with a significantly improved odds ratio of remission in patients on maintenance infliximab [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.9-1.2, P = 0.9]. The risk of surgery was significantly reduced in those receiving immunomodulators at the commencement of maintenance infliximab (OR 0.3, 95% CI 0.1-0.7, P = 0.01), but not in patients who continued maintenance concomitant therapy (OR 0.4, 95% CI 0.1-1.5, P = 0.1). The combination of maintenance infliximab and an immunomodulator produced modest improvements in outcomes beyond maintenance infliximab alone in this cohort.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 96%

Impact of Concomitant Immunomodulator Use on Long-Term Outcomes in Patients Receiving Scheduled Maintenance Infliximab

et al. 2009

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“…[57][58][59][60] After applying all inclusion and exclusion criteria, five studies were included for the purpose of this review; three reporting on CD and two on UC. 18,[61][62][63][64] See for a detailed overview of these studies Tables 1 and 2.…”

Section: Search Results For Infliximabmentioning

confidence: 99%

Systematic review: steroid withdrawal in anti‐TNF‐treated patients with inflammatory bowel disease

Bultman

Kuipers

Woude

2010

Aliment Pharmacol Ther

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“…Similarly, one of the first observations of SARS-CoV-2 from Wuhan, China did not report any COVID-19 case among 318 IBD patients [ 18 ]. Anti-TNF antibodies are frequently used for IBD therapy [ 19 , 20 , 21 ]. Our cohort included 52 patients who received anti-TNF treatments and experienced only a mild course of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

et al. 2022

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Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

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Combination therapy of infliximab and azathioprine reduces disease progression in Crohnʼs disease

Cited by 5 publications

References 9 publications

Impact of Concomitant Immunomodulator Use on Long-Term Outcomes in Patients Receiving Scheduled Maintenance Infliximab

Impact of Concomitant Immunomodulator Use on Long-Term Outcomes in Patients Receiving Scheduled Maintenance Infliximab

Systematic review: steroid withdrawal in anti‐TNF‐treated patients with inflammatory bowel disease

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

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