Crohn’s disease is an inflammatory condition of the digestive system which tends to flare up and follow a chronic course. Complications of Crohn’s disease can include painful fistulas and abscesses. The standard treatment for Crohn’s disease is a corticosteroid, which may be followed by a drug called azathioprine if the patient does not respond to the steroid. More recently, biologic treatments known as monoclonal antibodies have been introduced. These block a key molecule of the inflammatory cascade known as tumor necrosis factor (TNF). Infliximab is a biologic treatment for Crohn’s disease. It has to be given by infusion and it is expensive. Therefore, infliximab is generally reserved for patients in whom all other treatments have failed. But could more patients with Crohn’s disease benefit from infliximab? To answer this, a comparison between infliximab, azathioprine and a combination of the two is needed.

A multinational team, led by doctors in Lille, France, assigned one of three treatments to a group of 508 adults with moderate to severe Crohn’s disease who had not previously received immunosuppressive (azathioprine) treatment or a biologic treatment. One group received an infusion of infliximab at weeks 0, 2 and 8 together with daily placebo. Another received azathioprine capsules and a placebo infusion on the same schedule as the first group. And the third group had combination therapy with both drugs.

At week 26, 57% of those on combination therapy were in remission, compared to 44% of those on infliximab and 30% of those on azathioprine. At this time, pathology studies showed healing of the gut mucosa in 44% of those on combination therapy, 30% of those on infliximab and 16% of those on azathioprine. Therefore, for those with moderate to severe Crohn’s disease, infliximab either alone or in combination looks like a better treatment than azathioprine alone.

Source:

Colombel J et al Infliximab, azathioprine, or combination therapy for Crohn’s disease New England Journal of Medicine 15^th April 2010; 362:1383-95