Combined Immunosuppression vs. Sequential Therapy in Early Crohn Disease

Treatment of Crohn disease usually begins with corticosteroids, with antimetabolites and tumor necrosis factor (TNF) blockers added sequentially if required. In rheumatoid arthritis, which resembles Crohn disease pathophysiologically, antimetabolites and TNF antagonists now are used more commonly in early therapy. Should combined early immunosuppressive therapy be considered for patients with Crohn disease as well?

In a 2-year trial, researchers in Europe randomized 133 patients with early Crohn disease (duration, ≤4 years; never treated with corticosteroids, antimetabolites, or biologicals) to one of two treatment strategies: initial immunosuppression with infliximab and azathioprine, followed by azathioprine monotherapy (steroids also were…