In the first study (J Cheng et al. Inflamm Bowel Dis 2017; 23: 1762-73), the authors retrospectively reviewed 148 children (113 with Crohn’s disease, 35 with ulcerative colitis). 90 patients received concomitant therapy (infliximab with either a thiopurine [n=67], methotrexate [n=23]) and 58 received infliximab monotherapy. Key findings:
- Concomitant therapy >6 months significantly lowered the risk of secondary loss of response in Crohn’s disease (CD) (HR =0.39) compared to monotherapy. A similar trend was noted with ulcerative colitis (UC) but did not reach statistical significance.
- Steroid-free remission rates at 1 year were 78% for CD patients with concomitant therapy compared with 54% on monotherapy
- Among primary nonresponders, 67% of CD patients and 75% of UC patients were receiving IFX monotherapy.
- No differences in adverse events were evident between patients receiving monotherapy compared with concomitant therapy. One patient (receiving azathioprine) developed a follicular lymphoma; this patient was well 10 years later.
The second study (Y Qui et al. Clin Gastroenterol Hepatol 2017; 15: 1359-72) was a systemic review of 35 studies that met the authors’ inclusion criteria. In total, 6790 patients with inflammatory bowel disease were enrolled in these studies. This study looked at multiple anit-TNF agents including infliximab, adalimumab, certolizumab, and golimumab. Key finding:
- Antidrug antibodies were reduced by 51% in patients receiving concomitant therapy
- Conclusion from authors: “concomitant use of immunomodulators should be considered in patients treated with anti-TNF treatment.”
My take: Overall, for most pediatric patients with CD, to date, concomitant therapy has been the most effective treatment. More prospective studies are needed to determine more conclusively the benefit and optimal duration/timing of combined therapy, particularly with the more frequent use of therapeutic drug monitoring. Also, as will be noted in future posts from annual meeting, thiopurine use is declining.
More on this topic tomorrow.
Related blog posts:
- Combination therapy with adalimumab –is it helpful?
- ‘Don’t Believe Our Study’
- Should All Pediatric Patients with Crohn’s Disease Continue …
- Don’t be Fooled About Withdrawing Immunomodulator …
- Digging into the COMMIT Study | gutsandgrowth
- Support for Step-Up Therapy and Thiopurines | gutsandgrowth
- More NASPGHAN Meeting Notes –Hot Topics
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.