Withdrawal of Immunomodulators During Maintenance Therapy for Crohn Disease

For Crohn disease patients who achieve remission with infliximab, the advantages of cotherapy with an immunomodulator include lower risk for developing antibodies against infliximab, fewer infusion reactions, and higher blood levels of infliximab. However, cotherapy is also associated with excess risk for infection and cancer. Recently, occurrence of aggressive and fatal T-cell hepatosplenic lymphomas in young patients who were treated with infliximab and immunomodulators has raised new concerns about cotherapy (Inflamm Bowel Dis 2007; 13:1024).

In a recent study, researchers in Belgium enrolled 80 patients (age, ≥16 years) with controlled Crohn disease after at least 6 months of maintenance therapy with infliximab and an immunomodulator (az…