Response to stopping azathioprine in Crohn's patients on combined treatment with infliximab

The use of immunomodulatory agents has changed the management of inflammatory bowel disease. Immunosuppressive drugs (mainly thiopurines) and biological treatments (mainly monoclonal antibodies against TNFalpha) are currently most frequently and earlier used. The recent report of new cases of the ra...

Full description

Saved in:
Bibliographic Details
Published inAnales de pediatría (Barcelona, Spain : 2003) Vol. 70; no. 3; pp. 271 - 277
Main Authors Martín De Carpi, J, Varea, V
Format Journal Article
LanguageSpanish
Published Spain 01.03.2009
Subjects
Online AccessGet full text

Cover

Loading…
More Information
Summary:The use of immunomodulatory agents has changed the management of inflammatory bowel disease. Immunosuppressive drugs (mainly thiopurines) and biological treatments (mainly monoclonal antibodies against TNFalpha) are currently most frequently and earlier used. The recent report of new cases of the rare and almost always fatal hepatosplenic T-cell lymphoma in young patients on combined therapy with azathioprine/6-mercaptopurine and infliximab suggests that the optimal strategies for reducing increased risk of side-effects need to be urgently assessed. We report the effects of stopping immunosupressants in four Crohn's disease patients previously treated with azathioprine and infliximab for 6-12 months as combined therapy. The appearance of infusion reactions due to immunogenicity and the loss of efficacy of infliximab are evaluated. No adverse events attributable to immunosuppression cessation or changes in infliximab efficacy have been noted during a 6-month evaluation period. Stopping immunosuppressant therapy in Crohn's patients with a previous good response to combination therapy (azathioprine and infliximab) does not result in an increased risk of adverse events or loss of infliximab efficacy. Our results must be confirmed in larger and longer studies. Until the pathogenic role of this combined therapy in the incidence of hepatosplenic T-cell lymphoma is clearly defined, we consider that monotherapy with infliximab after a period on combined treatment is a safe and effective strategy.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
ObjectType-Report-3
ObjectType-Case Study-4
ISSN:1695-4033
1695-9531
DOI:10.1016/j.anpedi.2008.09.014