A study led by Mayo Clinic has found that infliximab (Remicade®) administered alone (monotherapy) or in combination with azathioprine is a more effective treatment for patients with moderate to severe Crohn’s disease than azathioprine alone. The findings were presented Oct. 6 at the 2008 American College of Gastroenterology (ACG) Annual Meeting.
Crohn’s disease is an inflammatory disorder of the gastrointestinal tract that affects an estimated 500,000 people in the United States. Symptoms include abdominal pain, fever, nausea, vomiting, weight loss and diarrhea. Crohn’s disease has no known medical cure.
“Historically, patients with Crohn’s disease have been treated sequentially with steroids, then azathioprine, then monoclonal antibodies such as infliximab. The study definitively demonstrates that infliximab-based strategies are more effective than azathioprine,” says William Sandborn, M.D., the lead author and a gastroenterologist at Mayo Clinic. “Clinicians should consider a shift in practice to incorporate this new data.”
The study, conducted at more than 130 sites, included 508 patients who have moderate to severe Crohn’s disease. Researchers found that 57 percent of patients who received combination therapy with infliximab and azathioprine achieved steroid-free remission after 26 weeks. This is compared to 44 percent of patients who achieved remission with infliximab monotherapy and 30 percent with azathioprine alone. Both the infliximab combination therapy and infliximab monotherapy groups were statistically superior to the azathioprine group. In addition, 61 percent of patients who received the combination therapy of infliximab and azathioprine also experienced healing of the bowel demonstrated by colonoscopy (mucosal healing).
Dr. William Sandborn, a Mayo Clinic gastroenterologist and the lead researcher on the study, provides background on the disease and describes the study purpose and findings below.
I hope know some Things about my medicines Hummera * because nobody In my country *helped me to know I do not know English well But I hope that you will help me in that am from
Saudi Arabia
Aboso me please
Hello – someone from our Mayo Clinic International Office will be emailing you with more information.
The link to that office is:
http://www.mayoclinic.org/english/appointments.html
Thank you.
I was just wandering when the doctor said that combination of the therapies increases the side effects a little, how is he justifying lymphoma or any type of cancer a a small risk. He also said that they did not find too much toxicity from the drugs through out the trial. The trial was done for 6 months, the people that will be prescribed these drugs will be on them for the rest of their life. How do they know that the toxicity levels will not increase the longer you are on the drugs?
I have had two bowel resections, 6 anal fistulas,perirectal abscess I& D several times, gall bladder removed, uterus and ovaries removed,erthema nodosum in my leg, and sepsis from a pic line which my vein in my arm had to be removed, had to have a thoracenteis to drain the lung, chest tube inserted after sepsis My mother had lymphoma. I am considering taking Remicade since now I have crohn’s in small intestine in the jenjum. Any research done on the chances of me getting lymphoma since my mother had it? I was taking Asacol and now taking Pentasa. After 10 years straight of taking prednisone my bowel perforated which caused the first surgery. I do not want to have a 3rd surgery and am at a lost of what to do. I am scared of taking Remicade or Humira and am at a lost as to what to do. Any comments greatly appreciated.
My husband suffers from Crohn’s disease; he was diagnosed in 2000. He had his first surgery in 1991 (they didn’t know then that he had Crohn’s yet). His second surgery was in 2004. He has been on remicade since 2005. He we are again and he needs more surgery (another fistula). He has lost so much weight; he’s always sick; diareaha all day everyday vomiting, he has bumps that seem like bug bites but aren’t they flare up all the time in different places mostly his face neck and legs. He has something bothering his eye that seems to be the same thing just extra irritating because its on his eye. He often times wakes up realizing that he didn’t make it to the bathroom this has become more frequent. He doesn’t want to eat because of the fear of how it will feel to come out. He is supposed to have surgery soon but we are scared that mabey we he needs to be seen by
someone- to possibly find something that works better for him. However what role does insurance play in this? He has keystone 65 and is on disability although he is only 30 years old. Please respond I’m worried about this surgery. Thank you Alicia Thompson
I would recommend you call the Mayo Clinic Inflammatory Bowel Disease Clinic at 507-538-3270 (Minnesota) or visit our web site for more information on appointments: http://www.mayoclinic.org/ibd/
Thank you.
My son was diagnosed with Crohn’s. His father is now 54 years old and was diagnosed with Crohn’s at the age of 12. My son is 12. My husband has had almost all his intestines removed when he was in his teens and 20′s, he has approximately 8-inches of small intestines remaining. We live in a small town of about 30,000 in North Dakota. I am very consered about my son’s treatment for the Crohn’s. We have one hospital in town, Trinity. They are not known for quality care. Even though I have dealt with Crohn’s with my husband, he has been in remittance for over 20 years. His condition without intestines is very different from my son’s. What should I do? Should we try to receive help at Mayo in Minnesota? My husband was treated there about five years ago for pancreitis and other complications from his Crohn’s. I need soem advise and information about my son’s diet. Any assistance would be greatly appreciated.
The appointment number for Mayo Clinic’s Pediatric Gastroenterology is 507-266-4950.
My son has Crohns he is 10 years old and was diognosied at the age of 5. He has tried remicade and many other treatments. First he had the 3 dose treatment. Then a year later we tried it again and he started to get a rash around his mouth after starting the second dose. The Dr. immediatly stopped the remicade and said it does not work. We are now facing surgery and I wanted to ask Dr. Sandborn if he knows of any other treatment we could try. My sons Dr. had told us that we have tried everything. He is currently taking Humira 40mg. But his last colonoscopy showed that the inflimation is great and not responding.
Thank you for your comment on Crohns disease. It has been forwarded for further information.
I have had Crohn’s disease for approx. 29 years, but only diagnosed 10 years ago.I am currently on 3000mg of Pentasa daily which is controlling my symptoms. My doctor wants to put me on Imuran, which I have heard can cause cancer long term. My doctor says it will not in small doses, and if I stay on Pentasa, surgery will eventually be needed.I feel that why change meds if I am in remission, but would like to avoid surgery. I would like to hear from other patients on Imuran and if it has helped them…Please respond & help me decide what to do!
i have been recently diagnosed with Chrones by my surgeon although all biopsies showed nothing definitive. I have fistuela and frequent diahrea. I have had 2 relapses bouts. 1 in october of 2008 where I lost 45 pounds and december 2009 through today where I have lost 22 pounds. doctors are recomending remicade and call me a fool for questioning the “black box” FDA warning asking if there are alternatives to using such a harsh drug as the first line of defense. should I just get better and see how it goes? or with fistuela do I need to take care of it.
My daughter is now 26 and diagnosed with Crohns 3 years ago. She started with the oral medications, then Remicade, Humira,and now Tysabri. None seemed to help much. Although her colon inflamation seemed to go down with the Tysabri she has gotten an internal colon infection along with a constriction of the blood vessels going to her legs causing them to swell. The GI doctor is recommended taking out the colon. We are not sure we want to take such a radical step yet but don’t know what else to do. Can you help?
I would recommend you call the Mayo Clinic Inflammatory Bowel Disease Clinic at 507-538-3270 (Minnesota) or visit our web site for more information on appointments: http://www.mayoclinic.org/ibd/
I had surgery for a blockage. They had to take out a foot of my small intestine and told me I had Crohns disease. I am now on Asacol and still have some pain. The doctor mentioned Remicade which can cause lymphoma. My husband suffered six and half years from lymphoma which he was treated at Mayo clinic in Rochester.He passed away in 2008. Because of that it scares me to even think of trying Remicade. I have read some of the concerns on this sight which I can relate to. I am getting myself so worked up over this and I know that is not good either. Any answers or help would be appreciated.
Crohn’s disease usually recurs if untreated and requires long term suppressive maintenance therapy. Drugs that contain mesalamine (like Asacol) in many instances do not adequately suppress the Crohn’s disease. Immunosuppressive medications like azathioprine and 6-mercaptopurine and biologic drugs like infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia) can suppress Crohn’s disease and maintain remission. They have small but real risks of serious infection and lymphoma. The risks of the drug side effects have to be considered against the risk of recurrent Crohn’s disease (which can lead to bowel blockage, fistulas, and abscess which is a form of serious infection). For many patients, the benefits of suppressing the Crohn’s disease with these medications outweighs the risks from the medications. This benefit risk decision is an individual and personal decision for each patient, and is best made in the context of a one on one visit with their physician.
William J. Sandborn, M.D.
I have had Crohn’s Disease for 20 years. I’ve had 3 surgeries on my small and large intestines and one fiscula. I have been sick for so long and it never stops permanently. Right now I take Remicade treatments 15mg every 8 weeks. It does help me to have a more “normal” life, but I still have 2 or 3 days at a time when the Crohn’s still flares up and I am in the bed for 2 or 3 days at a time. My doctor informed me that I cannot have anymore surguries because I do not have enough intestine left to take out without having to have a coloscopy (a bag). This Disease is very depressing for me. I have missed so much out of my life, my diet is down to almost nothing and I have allienated myself from all my friends. Just being sick soo much. Really no one wants to here that your feeling well all the time, eventually they get tired of hearing about it, and I don’t blame them. My husband of 10 years is supportive but tired of me getting sick on a regular basis. I normally don’t eat red meat due to my Chrohn’s, but I made a meatloaf and the textures was soft, I had one piece and I was sick for 4 days. I’m sure a lot of people can relate to way I’m saying.
i have had chrones diease for over 30 years i am on humuria , my dr. retired and i need coloncopy and i am deathly afried. any one with help please wright.
Experts in our Mayo Clinic Inflammatory Bowel Disease Clinic at 507-538-3270 (Minnesota) can help with your questions. Also, please visit our web site for more information on appointments: http://www.mayoclinic.org/ibd/
My daughter was,as a last resort,instead of surgery,put on infliximab,the other day,she had a very bad reaction to it.the doctor said it was a phycotic episode,only I was with her,she could have harmed herself by accident. I know, not everyone reacts the same,but it was so bad,it lasted a day and a night,next morning she was fine,I don’t know whats going to happen now,she has heard so many scare stories about surgery,(shes 28 and was born premature,26 weeks)and is putting off surgery.she is in hospital at the moment,she had ab-sis on her bowel.
my daughter has had crohns since the age of 10 .Had her large bowel removed 10 years ago got ileostmoy.Went on to infliximab in August 209 had 3 months of it starting to go deaf but doctor want except its through infliximab.when she had her ileostomoy they left 5cm of bowel attached to rectum since then she had vaginal discharge which smelled from june last year210.Had operation in january because bowel had gone into vagina had second op in March to take muscal out of leg to repair rectum and vagina which had broken down .Now they want her to go back on infliximab which made her deaf and dont know what to do she was told by one doctor to come of it or she would be stone deaf she has two earing aids what would you do
We have received your comment and have forwarded it for reply.
Susan, Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help for your daughter from Mayo Clinic, please call one of our appointment offices. The numbers can be found at this link: http://www.mayoclinic.org/patientinfo/appointments.html