Remicade plus thiopurine for Crohn’s yields better outcomes in first 6 months
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Remicade plus optimized thiopurine was superior in patients with Crohn’s disease compared with infliximab monotherapy for response initiation, durability and clinical outcomes in the first 6 months after induction, according to recently published study results.
“Thereafter combination therapy yielded no clinical advantage, supporting consideration of thiopurine withdrawal on a casebycase basis,” Raphael P. Luber, MD, from the department of gastroenterology at The Alfred Hospital, Melbourne, Victoria, Australia, and colleagues wrote.
Luber and colleagues retrospectively identified patients with Crohn’s disease who received induction with infliximab (Remicade, Janssen) either with or without concomitant thiopurines. Investigators assessed the response to the induction of therapy and clinical outcomes in subsequent 6-month maintenance semesters.
“A [6thioguanine nucleotide (TGN)] level 235 pmoL/8x108 red blood cells was considered therapeutic,” Luber and colleagues wrote.
Among 89 total patients, researchers saw a higher response to induction in the combination therapy group compared with monotherapy (74% vs. 47%; P = .04). However, this effect was observed only in patients with therapeutic TGN (OR = 3.72; 95% CI, 1.0713).
“Combination therapy during induction yielded three times longer time to subsequent need for treatment escalation or treatment failure compared to monotherapy (29 vs. 9 months, P = .01), with both therapeutic and subtherapeutic TGNs independent predictors on multivariate analysis,” Luber and colleagues wrote.
According to researchers, no difference in outcomes was seen in 370 semesters between combination therapy and monotherapy (P = .42). Further, no difference was seen between treatment groups when stratified by therapeutic TGN compared with subtherapeutic TGN. There was a significantly higher remission rate seen in the first semester when comparing therapeutic and subtherapeutic TGN (76% vs. 33%; P = .02).
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