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Immunosuppression Benefits Crohn's Disease Patients

Immunosuppressants given in conjunction with infliximab reduce the formation of antibodies to infliximab, potentially improving response

TUESDAY, Sept. 25 (HealthDay News) -- In Crohn's disease patients treated with infliximab, concomitant immunosuppressive therapy improves infliximab pharmacokinetics and reduces formation of antibodies to infliximab, according to study findings published in the September issue of Gut.

Paul Rutgeerts, M.D., of University Hospital Gasthuisberg in Leuven, Belgium, and colleagues prospectively studied 174 patients who were treated with infliximab in an on-demand schedule, including 59 who were treated with no immunosuppressives, 50 who received concomitant methotrexate and 65 who received concomitant azathioprine.

The researchers found that the incidence of formation of antibodies to infliximab was higher in the no-immunosuppressives group (73 percent) than in the methotrexate and azathioprine groups (44 percent and 48 percent, respectively). They also found that the no-immunosuppressives group had lower median infliximab levels than the other two groups at four weeks after any follow-up infusion.

"At present, either short-term concomitant therapy (e.g., six to 12 months) or monotherapy with a biological agent, alone, appear to offer the best balance between short-term and long-term safety and efficacy for the treatment of inflammatory bowel disease," states the author of an accompanying editorial. "In settings in which episodic therapy is (inappropriately) demanded by regulatory or funding authorities, the benefit appears to favor concomitant therapy; although the risks related to both disease progression and potential toxicities exceed those related to monotherapy with an induction and maintenance regimen."

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