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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2017; 8(2): 103-113
Published online May 6, 2017. doi: 10.4292/wjgpt.v8.i2.103
Combination therapy for inflammatory bowel disease
Keith S Sultan, Joshua C Berkowitz, Sundas Khan
Keith S Sultan, Department of Medicine, Division of Gastroenterology, Hofstra Northwell School of Medicine, Manhasset, NY 11030, United States
Joshua C Berkowitz, Sundas Khan, Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY 11030, United States
Author contributions: Sultan KS designed and composed this review; Berkowitz JC and Khan S contributed to the design and composition of this review.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keith S Sultan, MD, Assistant Professor of Medicine, Department of Medicine, Division of Gastroenterology, Hofstra Northwell School of Medicine, 300 Community Dr., Manhasset, NY 11030, United States. ksultan@northwell.edu
Telephone: +1-516-3873990 Fax: +1-516-3873930
Received: March 7, 2017
Peer-review started: March 10, 2017
First decision: March 29, 2017
Revised: April 7, 2017
Accepted: April 23, 2017
Article in press: April 25, 2017
Published online: May 6, 2017
Processing time: 58 Days and 7 Hours
Core Tip

Core tip: The benefits of combination therapy (CT) with infliximab and azathioprine likely outweigh its risks in treatment naïve patients with moderate to severe Crohn’s disease and ulcerative colitis. A similar benefit in patients already failing biologics or immunomodulators is not as well defined. There is a lack of strong prospective evidence demonstrating a benefit for CT with adalimumab and an immunomodulator. While expert guidelines emphasize the use of CT, its use should be preceded by a careful weighing of the risks and benefits by the physician and patient, especially in scenarios where the strongest evidence for CT may not directly apply.