Combination Therapy With Infliximab and Azathioprine Improves Infliximab Pharmacokinetic Features and Efficacy: A Post Hoc Analysis

Jean Frédéric Colombel*, Omoniyi J. Adedokun, Christopher Gasink, Long Long Gao, Freddy J. Cornillie, Geert R. D'Haens, Paul J. Rutgeerts, Walter Reinisch, William J. Sandborn, Stephen B Hanauer

*Corresponding author for this work

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Background & Aims: Among immunosuppressive- and biologic-naïve patients with moderately-to-severely active Crohn's disease (CD), a higher proportion of those treated with the combination of infliximab and azathioprine achieved corticosteroid-free remission at week 26 (CSFR26) than those given infliximab monotherapy; patients given the combination therapy also had higher serum concentrations of infliximab. Enhanced benefit of combination therapy may occur through synergistic modes of action or the influence of azathioprine on infliximab pharmacokinetics. Methods: We analyzed data from 206 patients from whom week 30 serum samples were available: 97 received infliximab monotherapy (5 mg/kg, n = 97) and 109 received combination therapy (2.5 mg/kg/day; n = 109). Proportions of patients achieving CSFR26 and mucosal healing (absence of ulcers) at week 26 were calculated for each quartile of serum concentrations of infliximab, and exposure–response relationships were compared. Results: Within quartiles of serum concentrations of infliximab, CSFR26 did not differ significantly between patients who received combination therapy vs monotherapy. However, among patients in the lowest quartile of serum concentration of infliximab, twice as many patients who received infliximab monotherapy achieved CSFR26 vs combination therapy. Anti-drug antibodies were detected only in the lowest quartile of serum concentrations of infliximab—in 35.9% of patients given monotherapy and 8.3% of patients given combination therapy. Conclusion: Among patients with CD and similar serum concentrations of infliximab, combination therapy with azathioprine was not significantly more effective than infliximab monotherapy. Combination therapy with azathioprine appears to improve efficacy by increasing pharmacokinetic features of infliximab. ClinicalTrials.gov, NCT00094458.

Original languageEnglish (US)
Pages (from-to)1525-1532.e1
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number8
DOIs
StatePublished - Jul 1 2019

Keywords

  • Corticosteroid-Free Clinical Remission
  • Exposure-Response
  • Mucosal Healing
  • SONIC
  • Serum Infliximab Concentrations

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Colombel, J. F., Adedokun, O. J., Gasink, C., Gao, L. L., Cornillie, F. J., D'Haens, G. R., Rutgeerts, P. J., Reinisch, W., Sandborn, W. J., & Hanauer, S. B. (2019). Combination Therapy With Infliximab and Azathioprine Improves Infliximab Pharmacokinetic Features and Efficacy: A Post Hoc Analysis. Clinical Gastroenterology and Hepatology, 17(8), 1525-1532.e1. https://doi.org/10.1016/j.cgh.2018.09.033