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Combination therapy for inflammatory bowel disease
Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy (CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunog...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421108/ https://www.ncbi.nlm.nih.gov/pubmed/28533919 http://dx.doi.org/10.4292/wjgpt.v8.i2.103 |
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author | Sultan, Keith S Berkowitz, Joshua C Khan, Sundas |
author_facet | Sultan, Keith S Berkowitz, Joshua C Khan, Sundas |
author_sort | Sultan, Keith S |
collection | PubMed |
description | Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy (CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunogenicity, and improve outcomes. The landmark SONIC trial in Crohn’s disease and the UC SUCCESS trial in ulcerative colitis demonstrated CT with infliximab and azathioprine to be superior to monotherapy with either agent alone at inducing clinical remission in treatment naïve patients with moderate to severe disease. However, many unanswered questions linger. The role of CT in non-naive patients as well as the optimal duration of CT remains unknown. The effectiveness of CT with alternate biologics and/or alternate immunomodulators is not as clear, and it is unknown whether SONIC’s conclusions can be extrapolated beyond infliximab and azathioprine. Also looming are the risks of CT including opportunistic infection and malignancy; specifically, lymphoma. This review lays out the evidence as it pertains to the risks and benefits of CT as well as the areas that require further research. With this information in hand, the practitioner may develop a treatment strategy that best suits each individual patient. |
format | Online Article Text |
id | pubmed-5421108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-54211082017-05-22 Combination therapy for inflammatory bowel disease Sultan, Keith S Berkowitz, Joshua C Khan, Sundas World J Gastrointest Pharmacol Ther Minireviews Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy (CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunogenicity, and improve outcomes. The landmark SONIC trial in Crohn’s disease and the UC SUCCESS trial in ulcerative colitis demonstrated CT with infliximab and azathioprine to be superior to monotherapy with either agent alone at inducing clinical remission in treatment naïve patients with moderate to severe disease. However, many unanswered questions linger. The role of CT in non-naive patients as well as the optimal duration of CT remains unknown. The effectiveness of CT with alternate biologics and/or alternate immunomodulators is not as clear, and it is unknown whether SONIC’s conclusions can be extrapolated beyond infliximab and azathioprine. Also looming are the risks of CT including opportunistic infection and malignancy; specifically, lymphoma. This review lays out the evidence as it pertains to the risks and benefits of CT as well as the areas that require further research. With this information in hand, the practitioner may develop a treatment strategy that best suits each individual patient. Baishideng Publishing Group Inc 2017-05-06 2017-05-06 /pmc/articles/PMC5421108/ /pubmed/28533919 http://dx.doi.org/10.4292/wjgpt.v8.i2.103 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Minireviews Sultan, Keith S Berkowitz, Joshua C Khan, Sundas Combination therapy for inflammatory bowel disease |
title | Combination therapy for inflammatory bowel disease |
title_full | Combination therapy for inflammatory bowel disease |
title_fullStr | Combination therapy for inflammatory bowel disease |
title_full_unstemmed | Combination therapy for inflammatory bowel disease |
title_short | Combination therapy for inflammatory bowel disease |
title_sort | combination therapy for inflammatory bowel disease |
topic | Minireviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421108/ https://www.ncbi.nlm.nih.gov/pubmed/28533919 http://dx.doi.org/10.4292/wjgpt.v8.i2.103 |
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