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Considerable controversy surrounds the optimal use of biological agents for Crohn disease (CD): Are biologics best used as first-line therapy to induce clinical remission or as second-line treatment for patients who fail to respond to corticosteroids or immunomodulators (6-mercaptopurine, azathioprine, and methotrexate)? Although many trials of biological agents for CD have been performed, these trials were typically placebo controlled rather than head-to-head comparisons. Now, early immunosuppression therapy with infliximab and azathioprine (or methotrexate in azathioprine-intolerant patients) has been compared to corticosteroid therapy in a randomized, controlled trial.
The 133 study participants (age range, 16–75) were recruited from 18 c…