COMMENTARY

Inflammatory bowel disease

Risks and benefits of combining immunosuppressives and biological agents in inflammatory bowel disease: is the synergy worth the risk?

Stephen B Hanauer

Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Hospital,Chicago, IllinoisUSA

Correspondence to:
Correspondence to:
Stephen B Hanauer
MD, Professor of Medicine and Clinical Pharmacology, and Chief, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Hospital, 5841 S. Maryland Ave., MC 4076, Chicago, Il 60637, USA; shanauer@uchicago.edu

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Since the introduction of infliximab to treat Crohn’s disease, combination therapy with immunosuppressants has reduced immunogenicity, without impacting efficacy. The availability of novel anti-TNF agents and potential combined toxicities question the risk/benefit of combination therapies.

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Keywords: Crohn’s disease; biologic therapy; anti-tumour necrosis factor; immunogenicity; immunosuppressive agents

The first 150 words of the full text of this article appear below.

Vermeire and colleagues have furthered our understanding of the effectiveness of concomitant immunosuppressive therapy in suppressing formation of antibodies to infliximab in Crohn’s disease (see page 1226).¹ The Leuven group has continued to demonstrate that immunosuppressive therapy reduces antibody formation to infliximab when the biological agent is administered on an episodic basis, and that antibody formation against infliximab correlates with lower infliximab blood levels and an increased risk of infusion reactions. In a year in which we can anticipate the introduction of two additional biological agents targeting tumour necrosis factor (TNF) (adalimumab and certolizumab) and, possibly, a third monoclonal antibody targeting 4 integrins (natalizumab) for the treatment of Crohn’s disease in the USA and Europe, the benefits and risks of combination therapy have become a primary focus of both efficacy and toxicity studies.

Monoclonal antibodies targeting TNF are highly effective therapies for the treatment of . . . [Full text of this article]

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Relevant Article

Effectiveness of concomitant immunosuppressive therapy in suppressing the formation of antibodies to infliximab in Crohn’s disease

Severine Vermeire, Maja Noman, Gert Van Assche, Filip Baert, Geert D’Haens, and Paul Rutgeerts
Gut 2007 56: 1226-1231. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Sorrentino, D., Terrosu, G., Avellini, C. (2008). Risks of Combining Immunosuppressive and Biological Treatments in Inflammatory Bowel Disease--Reply. Arch Intern Med 168: 667-668 [Full Text]