Immunosuppressant combined with infliximab in Crohn's Disease: For 6 months, for 2 years, or forever?

T he recently published article by Oussalah et al reports a retrospective analysis of a single-center cohort of 48 patients with luminal Crohn’s disease (CD) treated by combined therapy with infliximab and azathioprine for at least 6 months and who then stopped azathioprine after a mean of 30.2 months of combined therapy. The primary aim of the study was to analyze predictive factors of infliximab failure after azathioprine withdrawal. Infliximab failure was defined either as a disease flare requiring shortening of the dosing interval or increasing the infliximab dose to 10 mg/ kg, or switching to adalimumab, as acute or delayed hypersensitivity reactions leading to infliximab discontinuation, or as CD-related surgery. The survival probabilities without infliximab failure were 85% (65%) at 12 months and 41% (618%) at both 24 and 32 months. Independent predictive factors of infliximab failures were combined therapy exposure <811 days, C-reactive protein (CRP) >5 mg/L, and platelet counts >298 10/L.