Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases

One Size Still Does Not Fit All

Gil Y. Melmed*, Gilaad G. Kaplan, Miles P. Sparrow, Fernando S. Velayos, Leonard K Baidoo, Brian Bressler, Adam S. Cheifetz, Shane M. Devlin, Peter M. Irving, Jennifer Jones, Patricia L. Kozuch, Laura E. Raffals, Corey A. Siegel

*Corresponding author for this work

Research output: Contribution to journalShort survey

Abstract

Randomized controlled trials (RCTs) have demonstrated that therapies targeting tumor necrosis factor (TNF) and α₄β₇ integrin are effective when given as monotherapy in inducing and/or maintaining remission in patients with ulcerative colitis (UC) or Crohn's disease (CD), but data from RCTs are less clear on whether concomitant immunomodulator (IM) therapy confers additional benefit. In CD, RCT data are mixed,1,2 as are results of systematic reviews and meta-analyses, showing no benefit overall,3 minimal benefit with individual agents,4 and comparative benefit over some monotherapies but not others.5 For example, concomitant azathioprine with infliximab is more effective than either drug alone in patients with CD naive to both drugs,2 but whether combination therapy is more effective than monotherapy with infliximab in nonnaive patients, or with other approved biologic drugs in any population, remains unknown. In UC, RCTs have shown that the benefit may be limited to specific populations,6 whereas systematic reviews suggest no benefit at all.7

Original languageEnglish (US)
Pages (from-to)1829-1831
Number of pages3
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number11
DOIs
StatePublished - Nov 1 2018

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Inflammatory Bowel Diseases
Randomized Controlled Trials
Crohn Disease
Ulcerative Colitis
Pharmaceutical Preparations
Azathioprine
Immunologic Factors
Therapeutics
Integrins
Population
Meta-Analysis
Tumor Necrosis Factor-alpha
Infliximab

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Melmed, G. Y., Kaplan, G. G., Sparrow, M. P., Velayos, F. S., Baidoo, L. K., Bressler, B., ... Siegel, C. A. (2018). Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases: One Size Still Does Not Fit All. Clinical Gastroenterology and Hepatology, 16(11), 1829-1831. https://doi.org/10.1016/j.cgh.2018.02.036
Melmed, Gil Y. ; Kaplan, Gilaad G. ; Sparrow, Miles P. ; Velayos, Fernando S. ; Baidoo, Leonard K ; Bressler, Brian ; Cheifetz, Adam S. ; Devlin, Shane M. ; Irving, Peter M. ; Jones, Jennifer ; Kozuch, Patricia L. ; Raffals, Laura E. ; Siegel, Corey A. / Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases : One Size Still Does Not Fit All. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 11. pp. 1829-1831.
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abstract = "Randomized controlled trials (RCTs) have demonstrated that therapies targeting tumor necrosis factor (TNF) and α₄β₇ integrin are effective when given as monotherapy in inducing and/or maintaining remission in patients with ulcerative colitis (UC) or Crohn's disease (CD), but data from RCTs are less clear on whether concomitant immunomodulator (IM) therapy confers additional benefit. In CD, RCT data are mixed,1,2 as are results of systematic reviews and meta-analyses, showing no benefit overall,3 minimal benefit with individual agents,4 and comparative benefit over some monotherapies but not others.5 For example, concomitant azathioprine with infliximab is more effective than either drug alone in patients with CD naive to both drugs,2 but whether combination therapy is more effective than monotherapy with infliximab in nonnaive patients, or with other approved biologic drugs in any population, remains unknown. In UC, RCTs have shown that the benefit may be limited to specific populations,6 whereas systematic reviews suggest no benefit at all.7",
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Melmed, GY, Kaplan, GG, Sparrow, MP, Velayos, FS, Baidoo, LK, Bressler, B, Cheifetz, AS, Devlin, SM, Irving, PM, Jones, J, Kozuch, PL, Raffals, LE & Siegel, CA 2018, 'Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases: One Size Still Does Not Fit All', Clinical Gastroenterology and Hepatology, vol. 16, no. 11, pp. 1829-1831. https://doi.org/10.1016/j.cgh.2018.02.036

Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases : One Size Still Does Not Fit All. / Melmed, Gil Y.; Kaplan, Gilaad G.; Sparrow, Miles P.; Velayos, Fernando S.; Baidoo, Leonard K; Bressler, Brian; Cheifetz, Adam S.; Devlin, Shane M.; Irving, Peter M.; Jones, Jennifer; Kozuch, Patricia L.; Raffals, Laura E.; Siegel, Corey A.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 11, 01.11.2018, p. 1829-1831.

Research output: Contribution to journalShort survey

TY - JOUR

T1 - Appropriateness of Combination Therapy for Patients With Inflammatory Bowel Diseases

T2 - One Size Still Does Not Fit All

AU - Melmed, Gil Y.

AU - Kaplan, Gilaad G.

AU - Sparrow, Miles P.

AU - Velayos, Fernando S.

AU - Baidoo, Leonard K

AU - Bressler, Brian

AU - Cheifetz, Adam S.

AU - Devlin, Shane M.

AU - Irving, Peter M.

AU - Jones, Jennifer

AU - Kozuch, Patricia L.

AU - Raffals, Laura E.

AU - Siegel, Corey A.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Randomized controlled trials (RCTs) have demonstrated that therapies targeting tumor necrosis factor (TNF) and α₄β₇ integrin are effective when given as monotherapy in inducing and/or maintaining remission in patients with ulcerative colitis (UC) or Crohn's disease (CD), but data from RCTs are less clear on whether concomitant immunomodulator (IM) therapy confers additional benefit. In CD, RCT data are mixed,1,2 as are results of systematic reviews and meta-analyses, showing no benefit overall,3 minimal benefit with individual agents,4 and comparative benefit over some monotherapies but not others.5 For example, concomitant azathioprine with infliximab is more effective than either drug alone in patients with CD naive to both drugs,2 but whether combination therapy is more effective than monotherapy with infliximab in nonnaive patients, or with other approved biologic drugs in any population, remains unknown. In UC, RCTs have shown that the benefit may be limited to specific populations,6 whereas systematic reviews suggest no benefit at all.7

AB - Randomized controlled trials (RCTs) have demonstrated that therapies targeting tumor necrosis factor (TNF) and α₄β₇ integrin are effective when given as monotherapy in inducing and/or maintaining remission in patients with ulcerative colitis (UC) or Crohn's disease (CD), but data from RCTs are less clear on whether concomitant immunomodulator (IM) therapy confers additional benefit. In CD, RCT data are mixed,1,2 as are results of systematic reviews and meta-analyses, showing no benefit overall,3 minimal benefit with individual agents,4 and comparative benefit over some monotherapies but not others.5 For example, concomitant azathioprine with infliximab is more effective than either drug alone in patients with CD naive to both drugs,2 but whether combination therapy is more effective than monotherapy with infliximab in nonnaive patients, or with other approved biologic drugs in any population, remains unknown. In UC, RCTs have shown that the benefit may be limited to specific populations,6 whereas systematic reviews suggest no benefit at all.7

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U2 - 10.1016/j.cgh.2018.02.036

DO - 10.1016/j.cgh.2018.02.036

M3 - Short survey

VL - 16

SP - 1829

EP - 1831

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

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