A study led by Mayo Clinic suggests remission from Crohn’s disease may be more likely if patients get biologic therapy, combined with immune-suppressing drugs first, instead of immune-suppressing drugs alone. The study, published in the April 15, 2010, issue of the New England Journal of Medicine, found that treatment of moderate to severe Crohn’s disease with infliximab plus azathioprine leads to remission and mucosal healing in more patients than therapy with azathioprine alone.
“These study results are strong enough to change clinical practice,” says William Sandborn, M.D., gastroenterologist and vice chair of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester. “They have certainly changed mine.”
The researchers in the international, multicenter SONIC study recruited 508 patients with Crohn’s disease who were naive to immunomodulator drugs. Of these patients who were randomized to treatment,169 got infliximab monotherapy, 170 azathioprine monotherapy, and 169 infliximab plus azathioprine combination therapy. Patients underwent colonoscopies at a pre-study examination and again at week 26. Patients still in the trial at week 30 were given the option of continuing in a blinded extension trial for another 20 weeks.
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 showed better response than the azathioprine group. These results were similar through week 50.
“Results of this study will provide doctors and their patients with more information on how to use these drugs most appropriately to most effectively treat Crohn’s disease,” says Dr. Sandborn. “For the first time, we have longer-term outcome data on the advantages of combination therapy that will help guide our treatment of patients with Crohn’s disease.”
Below is a link to an edited youtube video with Dr. Sandborn.