Usefulness of thiopurine and scheduled infliximab combination therapy in non-immunomodulator-naïve Crohn’s disease (CD) patients and the optimal length of dual therapy are still debated.
Dr Monika Fischer and colleagues determined proportion of patients developing disease flare requiring rescue therapy and risk factors associated with disease flare after de-escalation of immunomodulator from combination therapy.
Adult CD patients in clinical remission on combination therapy were identified from a large single-center database between 2002 and 2009.
Patients who had their immunomodulator stopped in the absence of adverse events were included.
|72% required rescue therapy during follow-up|
|Digestive Diseases & Sciences|
Association between clinical and demographic variables and time until rescue therapy was analyzed using Cox-proportional hazard models.
The research team found that 43 CD patients on combination therapy in clinical remission at time of immunomodulator de-escalation were identified and followed up for a median duration of 62 months.
Median duration of remission on combination therapy prior to immunomodulator de-escalation was 12 months.
The researchers noted that 72% required rescue therapy during follow-up.
The team observed that age at diagnosis less than 16 years versus more than 40 years, using methotrexate instead of azathioprine in combination with infliximab, and duration of combination therapy less than 6 months increased risk for rescue therapy.
Dr Fischer's team comments, "A large proportion of CD patients on combination therapy experienced a flare following immunomodulator withdrawal."
"Young age at diagnosis, short duration of combination therapy, and methotrexate use were independent predictors of the need for rescue therapy."