Ward MG, Irving PM, Sparrow MP. How should immunomodulators be optimized when used as combination therapy with anti-tumor necrosis factor agents in the management of inflammatory bowel disease? World J Gastroenterol 2015; 21(40): 11331-11342 [PMID: 26525434 DOI: 10.3748/wjg.v21.i40.11331]
Corresponding Author of This Article
Dr. Miles P Sparrow, Department of Gastroenterology, The Alfred Hospital, Melbourne 3004, Australia. m.sparrow@alfred.org.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
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/
World J Gastroenterol. Oct 28, 2015; 21(40): 11331-11342 Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11331
How should immunomodulators be optimized when used as combination therapy with anti-tumor necrosis factor agents in the management of inflammatory bowel disease?
Mark G Ward, Peter M Irving, Miles P Sparrow
Mark G Ward, Miles P Sparrow, Department of Gastroenterology, The Alfred Hospital, Melbourne 3004, Australia
Peter M Irving, Department of Gastroenterology, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
Author contributions: All authors substantially contributed to the writing of this article and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict 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: Dr. Miles P Sparrow, Department of Gastroenterology, The Alfred Hospital, Melbourne 3004, Australia. m.sparrow@alfred.org.au
Telephone: +61-3-90762223 Fax: +61-3-90762194
Received: June 1, 2015 Peer-review started: June 3, 2015 First decision: June 23, 2015 Revised: July 14, 2015 Accepted: September 14, 2015 Article in press: September 15, 2015 Published online: October 28, 2015
Core Tip
Core tip: Clinicians managing inflammatory bowel disease frequently have to decide whether to use anti-tumor necrosis factor (anti-TNF) therapy alone or in combination with immunomodulators (IM), which requires an assessment of patient factors and the risk/benefit profile of each treatment strategy. Once a decision is made to use combination therapy, questions on how best to optimize IMs must be addressed. Thiopurines, rather than methotrexate, (MTX) are more efficacious and easier to administer, whereas in certain population groups, MTX may be safer. The effective dose of IM may be lower in combination therapy and combination therapy is probably most important in the first 12 mo of treatment. Withdrawing IMs is best done when the patient is in deep remission, ideally supported by the use of therapeutic drug monitoring of anti-TNFs.
