Continued use of immunomodulator therapy in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy is no more effective than anti-TNF monotherapy in inducing or maintaining response or remission, researchers show. The meta-analysis of randomized controlled trials is published in the December issue of Clinical Gastroenterology and Hepatology.
Jennifer L. Jones et al conducted a meta-analysis of subgroups from 11 randomized controlled trials of anti-TNF agents (adalimumab, certolizumab, or infliximab) in patients with luminal or fistulizing Crohn’s disease. The trials all had primary end points of clinical response at weeks 4–14 and 24–30 and remission at weeks 24–30. The authors also performed subgroup analyses to evaluate fistula closure and the efficacy and safety of combination therapy with different anti-TNF agents.
In a video abstract, senior author Corey A. Siegel concludes “it didn’t really seem to matter whether you continue them on immune modulators or stop them and left them on anti-TNF monotherapy.”
The meta-analysis showed that combination therapy was no more effective than monotherapy in inducing 6-month remission, inducing or maintaining a response, or inducing a partial response or complete fistula closure.
However, Siegel says “My overall feeling is that after failing immune modulator therapy and starting anti-TNF therapy, you might to consider continuing the immune modulator for a period of time to decrease the immunogenicity of against the anti-TNF, but then we probably do have the ability to take away that immune modulator”
“It may make more of a difference for infliximab than the other drugs, but we’re not certain”, he added.
Jones et al state that randomized controlled trials are needed to fully assess the efficacy of continued immunomodulator therapy after anti-TNF therapy is initiated.