Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease

Which patients with inflammatory bowel disease should receive combination therapy?

“…However, the latter study really compares combination therapy with steroids and IFX to triple therapy with steroids, IFX and MTX. In addition, steroid-free remission rates in this study were nearly 70% in both groups, confirming that combination therapy in some form or the other is a highly effective strategy [9].…”

Therapeutic Drug Monitoring in Inflammatory Bowel Disease

“…In contrast, concomitant treatment with methotrexate failed to improve clinical response rates, possibly owing to a large proportion of patients being on corticosteroids at treatment onset in this particular trial [12]. Nonetheless, the latter study found higher trough levels of IFX and lower rates of antibody formation with methotrexate co-treatment [12].…”

“…Combination therapy with IFX and AZA in the SONIC study was associated with a superior clinical response, as well as higher 4-week IFX levels and lower prevalence of antibodies [11]. A combination of IFX with methotrexate resulted in a signifi cantly lower prevalence of ATI and a trend for higher serum IFX levels, although without a signifi cant diff erence in clinical effi cacy [12]. In these studies, an immunomodulator was initiated simultaneously with and anti-TNF.…”

“…In contrast to persistent ATI that rarely (<10%) appear aft er 1 year of treatment, these transient antibodies may be detected at any point during the treatment without a signifi cant impact on LORfree survival [31]. Th e risk of ATI formation has been repeatedly demonstrated to be lower in patients receiving concomitant immunomodulatory therapy [11,12,30]. Premedication with intravenous corticosteroids was reported to be associated with a lower rate of ATI formation by Farrell et al [33].…”

What is the need for comparative effectiveness studies in IBD?

“…Similarly, the 'Combination of Maintenance Methotrexate-Infliximab Trial' assessed whether methotrexate in addition to infliximab was superior to infliximab alone after corticosteroids in patients with moderate-severe CD [20]. Addressing another common clinical question, the Laparoscopic Ileocolic Resection Versus Infliximab Treatment of Recurrent Distal Ileitis in Crohn's Disease trial was initiated in 2008 to assess the impact of competing strategies of laparoscopic terminal ileal resection or infliximab for refractory CD ileitis [21].…”