Open AccessBiologic monotherapy versus combination therapy with immunomodulators in the induction and maintenance of remission of Crohn’s disease and ulcerative colitis
Author(s) -
Jana G. Hashash,
Carla G. Abou Fadel,
Hussein H. Rimmani,
Ala Sharara
Publication year - 2021
Publication title -
annals of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 33
eISSN - 1792-7463
pISSN - 1108-7471
DOI - 10.20524/aog.2021.0645
Subject(s) - medicine , ulcerative colitis , crohn's disease , disease , maintenance therapy , induction therapy , inflammatory bowel disease , gastroenterology , immunology , chemotherapy
Despite current guidelines, the optimal treatment of patients with inflammatory bowel disease (IBD) remains challenging. The available medications are not without risk and there is not a single correct treatment regimen for every patient. Personalizing treatment and selecting the most appropriate therapy is crucial for optimal response, remission, quality of life, and healthcare utilization. Biologics, especially anti-tumor necrosis factor-α medications, are widely used in the induction and maintenance of disease remission in patients with IBD. Similarly, immunomodulators, including thiopurines and methotrexate, are traditionally popular for the maintenance of remission. In this manuscript, we review the use of biologic monotherapy vs. combination therapy with immunomodulators for the treatment of ulcerative colitis and Crohn's disease. We examine overall remission, immunogenicity and adverse effects, mainly serious infections and malignancy, in an effort to help guide treatment decisions and weigh the risks and benefits of biologic monotherapy vs. combination therapy.