Infliximab Plus Azathioprine for Steroid-Dependent Crohn’s Disease Patients: A Randomized Placebo-Controlled Trial

Management of Crohn's Disease in Adults

“…Although a single infusion of in iximab at a dose of 5 mg / kg is e ective at reducing signs and symptoms of CD over 4 weeks (141) , an induction regimen of 5 mg / kg infusions at weeks 0, 2, and 6 followed by maintenance therapy (see below) has had signi cant advantages over episodic treatment strategies (55) . In iximab monotherapy and in iximab combined with azathioprine are more e ective than azathioprine in the treatment of patients with moderate to severe CD who have failed to respond to rst-line therapy with mesalamine and / or corticosteroids and are na ï ve to immunosuppressive and biologic agents (142,143) . Assessment of prior tuberculosis exposure, current puri ed protein derivative status, and a chest X-ray prior to treatment with in iximab are important as in iximab use has been associated with reactivation of latent tuberculosis (144) .…”

“…It remains to be determined whether patients can be " bridged " from in iximab induction therapy or in iximab maintenance therapy to long-term treatment with a thiopurine (143) . ere is increasing evidence that " top -down " therapy beginning with in iximab and azathioprine may o er steroid-sparing bene ts for steroid-na ï ve patients (229) .…”

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

“…[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.…”

Is There Still a Role for Thiopurines in Crohn's Disease?

“…15 Comparative effectiveness trials demonstrated that thiopurine monotherapy was less effective than combination therapy with thiopurines and TNF antagonists for induction and maintenance of steroid free remission over 6-12 months. 10,16 In 2000, Markowitz and colleagues reported that 6MP significantly lessened the need for prednisone and improved maintenance of remission in a study of 55 pediatric patients with new onset Crohn's disease who received a tapering course of prednisone. 17 However, the precise details of the reported results are that by 3 months, all 6MP patients and all but 1 placebo patient had achieved at least 1 inactive Harvey Bradshaw score, and that by 12 months, both groups had cumulative remission rates of 89%.…”

“…Two comparative effectiveness trials have demonstrated unequivocal superiority of combination therapy with thiopurines and TNF antagonist therapy with infliximab as compared with thiopurines alone, with no incremental increase in toxicity. 10,16 Therefore, the strongest indication for thiopurines may be as part of a combination therapy regimen. The recent post-hoc study reporting that combination therapy is more effective with infliximab than with adalimumab or certolizumab 23 is not reassuring, given that patients were not randomized to TNF antagonist monotherapy or combination therapy, and the results are not logical since drug withdrawal data with certolizumab show rates of immunogenicity with monotherapy that approach those observed with infliximab.…”