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The benefit of combination therapy depends on disease phenotype and duration in Crohn's disease
Author(s) -
Ananthakrishnan A. N,
Sakuraba A.,
Barnes E. L.,
Pekow J.,
Raffals L.,
Long M. D.,
Sandler R. S.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14125
Subject(s) - medicine , infliximab , combination therapy , crohn's disease , ulcerative colitis , confounding , prospective cohort study , disease , gastroenterology , inflammatory bowel disease , logistic regression , cohort
Summary Background The impact of combination therapy on disease‐related morbidity in patients with established Crohn's disease ( CD ) or ulcerative colitis ( UC ) remains to be well‐defined. Aim To examine the effect of combination therapy on disease outcomes in CD and UC. Methods Using a multicenter prospective cohort, we classified CD and UC patients as being on monotherapy with anti‐ TNF or on combination with an immunomodulator. The primary outcome was a composite of new IBD ‐related surgery, hospitalisations, penetrating complications, need for corticosteroids or new biological at 1 year. Multivariable regression models adjusted for potential confounders. Results We included 707 patients with CD (45% combination therapy) and 164 with UC (38% combination therapy). Combination therapy was not associated with reduction in the composite outcome in either CD ( OR : 0.87, 95% CI : 0.63‐1.22) or UC ( OR : 1.45, 95% CI : 0.63‐3.38). However, while no difference was noted in those with nonstricturing, nonpenetrating CD , a significant reduction in the likelihood of the outcome was seen in those with stricturing or penetrating CD (30% vs 39%, OR : 0.58, 95% CI : 0.37‐0.90). A stronger effect was also observed in those with disease duration <5 years ( OR : 0.35, 95% CI : 0.14‐0.87) compared to those with a longer duration ( OR : 0.75, 95% CI : 0.45‐1.27). A similar reduction in occurrence of composite outcome was noted with infliximab and with other anti‐ TNF biologics. Conclusion The benefit of combination immunomodulator‐biological therapy is stronger in those with complicated Crohn's disease, particularly early on in their disease course.