Beware of the swinging pendulum: anti-tumor necrosis factor monotherapy vs combination therapy for inflammatory bowel disease

IBD LIVE Case Series-Case 2: Previous Cancer in a Patient with Crohn's Disease: Is It Appropriate to Use Biologics and Immunosuppressants for IBD Treatment?

Article first published online 4 May 2015.

Infliximab and azathioprine combination therapy vs monotherapy for inflammatory bowel disease: A meta-analysis

AIM: To compare the efficacy and safety of infliximab (IFX) and azathioprine (AZA) combination therapy vs monotherapy in moderate to severe inflammatory bowel disease (IBD).

METHODS: A comprehensive literature search was performed in MEDLINE, EMBASE, PubMed, Ovid, Google, Wanfang database, Vip database, China National Knowledge Infrastructure database (CNKI) and the Chinese biomedical literature database of randomized controlled clinical trials about IFX and AZA in IBD. Data of the included studies were extracted and their quality was evaluated to conduct a meta-analysis.

RESULTS: Based on the inclusion criteria, 6 prospective randomized controlled clinical studies were included in this study. Clinical remission rate and endoscopic remission rate were significantly improved in the combination group when compared with IFX or AZA monotherapy. However, there was no significant statistical difference in overall adverse reactions between the two groups.

CONCLUSION: For patients with moderate to severe IBD who failed the first-line treatment, combination of IFX and AZA is superior to monotherapy. Combination therapy can improve clinical remission and endoscopic mucosal healing efficacy, although overall adverse reactions show no significant difference compared with monotherapy.