Combination Therapy for Crohn's Disease

Crohns combination drug treatment shows positive results

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Crohn's Disease has no known cure. The best doctors can do is safely and effectively treat the disease, but every treatment has its side effects.

One popular treatment for Crohn's is a combination therapy, using two immune-suppressing medications. These drugs have a reputation for lowering the body's resistance to infections.

But a new study has found that the benefits of the combination outweighs the risks.

"Ask your doctor about combination therapy for Crohn's."

The study was led by Cory A. Siegel, M.D., of the Dartmouth-Hitchcock Inflammatory Bowel Disease Center in Lebanon, New Hampshire. His team looked at combination therapy with infliximab and azathioprine (IFX/AZA), known by the trade names Remicade and Imuran, respectively.

These drugs work by suppressing the immune system response that causes painful inflammation for people with Crohn's, a chronic inflammatory condition, usually affecting the intestinal tract.

Previous studies have found that the IFX/AZA combination works better for patients than either drug taken on its own. But there have been cases where patients have developed serious infections.

Dr. Siegel's team constructed a decision model to determine whether the risks of prescribing this combination outweighs the benefits, and vice versa.

They used data from one year of the Study of Biologic and Immunomodulator-Naive Patients With Crohn's Disease, nicknamed SONIC.

The researchers used their model to analyze the benefits and risks for each patient.

Their results were firmly in favor of the combination treatment. They found that there would have to be more adverse medical events than seem clinically possible in order for the risks to outweigh the benefits.

Specifically, 20 percent or more of the patient population would have to get infections, or 3.9 percent of the patients would have lymphoma, in order for the study authors to advise against the treatment.

These estimates were five-fold and 65-fold greater than the base case estimates, they wrote in their paper.

Dr. Siegel and his team concluded that treatment with IFX/AZA was more effective than IFX alone, in the period of one year. Importantly, they found that the potential benefit of the therapy to a patient was much greater than the potential risk.

The study appeared online in December 2011, in the journal Clinical Gastroenterology and Hepatology.

Several authors disclosed financial relationships with pharmaceutical companies, including Abbott, Elan, Centocor, and Merck.

Reviewed by: 
Review Date: 
December 29, 2011
Last Updated:
October 21, 2012