Systematic review: monotherapy with antitumour necrosis factor {alpha} agents versus combination therapy with an immunosuppressive for IBD

Introduction The treatment of IBD has evolved significantly over the past 15 years. Historically, steroids and immunosuppressive drugs, such as methotrexate (MTX), azathioprine (AZA) and 6-mercaptopurine (6-MP) had been the mainstay of therapy. When infliximab (IFX) was approved for the treatment of Crohn's disease, it began the era of trying to understand how best to optimise our available treatment options. Initially, antitumour necrosis factor (anti-TNF) agents were used after immunosuppressives failed. Then, evidence showed that using AZA together with IFX early in the disease course was more effective than the typical sequential treatment algorithm.1 With the addition of newer anti-TNF drugs and development of different treatment regimens,2–5 there are still significant questions related to the most effective therapeutic strategy. Perhaps the most controversial of these questions is when to use anti-TNF monotherapy versus combination therapy with 6-MP, AZA or...

Source: Gut - October 31, 2014 Category: Gastroenterology Authors: Dulai, P. S., Siegel, C. A., Colombel, J.-F., Sandborn, W. J., Peyrin-Biroulet, L. Tags: Crohn's disease Leading article Source Type: research