272
Views
7
CrossRef citations to date
0
Altmetric
Original Article

Combination therapy in inflammatory bowel disease patients: do we need to maximize the dose of azathioprine?

, ORCID Icon, ORCID Icon, & ORCID Icon
Pages 920-923 | Received 07 Jun 2020, Accepted 29 Jun 2020, Published online: 20 Jul 2020
 

Abstract

Background

The use of combination therapy of anti-TNFα and thiopurines in inflammatory bowel disease (IBD) is associated with greater efficacy and lower immunogenicity. However, the dose of thiopurine in this setting remains to be elucidated.

Aim

To compare the trough levels, anti-TNFα antibodies and the inflammatory biomarkers between three groups in combotherapy: group 1 (dose of azathioprine <1 mg/kg); group 2 (dose of azathioprine ≥1 and <2 mg/kg), and group 3 (dose of azathioprine ≥2 mg/kg).

Methods

A retrospective study was performed, selecting all patients with established diagnosis of IBD who were on combined maintenance treatment.

Results

We included 99 patients, 52.5% female with median age 33 (17–61) years. Eighty patients (80.8%) were diagnosed with Crohn’s disease and 19 (19.2%) with ulcerative colitis. Seventy-one (71.8%) patients were on infliximab (IFX) and 28 (28.3%) were on adalimumab (ADA). In patients treated with IFX, there were no differences in trough levels (p=.976) or formation of antibodies anti-IFX (p=.478) between groups. Moreover, there were no differences in inflammatory biomarkers: CRP (p=.385) and fecal calprotectin (p=.576) among the three groups. Regarding patients treated with ADA, there were no differences in trough levels of ADA (p=.249), formation of antibodies anti-ADA (p=.706) or in inflammatory biomarkers: CRP (p=.738) and fecal calprotectin (p=.269) among the three groups.

Conclusion

In our cohort, there were no differences between anti-TNFα trough levels, formation of anti-TNFα antibodies or inflammatory biomarkers among patients in combotherapy with azathioprine, irrespective of its dosage. In conclusion, our study suggests that maintaining therapeutic levels of anti-TNFα drugs without antibodies formation is feasible with lower doses of azathioprine, minimizing its side effects.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Arieira C. and Dias de Castro F. designed the study, interpreted the data and drafted the manuscript.

Dias de Castro F., Cúrdia Gonçalves T., and Moreira M. J. critically revised the manuscript.

Cotter J. critically revised and approved the final version of the manuscript.

Log in via your institution

Log in to Taylor & Francis Online

PDF download + Online access

  • 48 hours access to article PDF & online version
  • Article PDF can be downloaded
  • Article PDF can be printed
USD 65.00 Add to cart

Issue Purchase

  • 30 days online access to complete issue
  • Article PDFs can be downloaded
  • Article PDFs can be printed
USD 336.00 Add to cart

* Local tax will be added as applicable

Related Research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.