Infliximab Failure After Azathioprine Withdrawal in Patients with Crohn Disease

Many patients with Crohn disease are treated with a combination of azathioprine (or 6-mercaptopurine) plus infliximab. In the recent SONIC trial, combination therapy with azathioprine plus infliximab was superior in achieving and maintaining steroid-free clinical remission at 6 months and 1 year compared to azathioprine alone or infliximab alone (N Engl J Med 2010; 362:1383). Further, infliximab is often added to the treatment of patients who fail to respond to azathioprine alone, and vice versa. However, many clinicians are concerned about the risk for opportunistic infections associated with combination therapy and about the occurrence of fatal hepatosplenic T-cell lymphomas in young patients who receive combination therapy. Therefore, so…