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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2018; 9(1): 8-13
Published online Feb 6, 2018. doi: 10.4292/wjgpt.v9.i1.8
Declining use of combination infliximab and immunomodulator for inflammatory bowel disease in the community setting
Joshua C Berkowitz, Joanna Stein-Fishbein, Sundas Khan, Richard Furie, Keith S Sultan
Joshua C Berkowitz, Sundas Khan, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Joanna Stein-Fishbein, Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Richard Furie, Department of Medicine, Division of Rheumatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Keith S Sultan, Department of Medicine, Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Author contributions: Berkowitz JC and Sultan KS designed the study, gathered, analyzed the data and composed the manuscript; Stein-Fishbein J contributed to data analysis and manuscript drafting; Khan S and Furie R contributed to data collection and to the drafting of the manuscript.
Institutional review board statement: This study was approved by the Northwell Health Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Data sharing statement: No additional data are available.
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, Associate Professor, Department of Medicine, Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr., Manhasset, NY 11030, United States. ksultan@northwell.edu
Telephone: +1-516-3873990 Fax: +1-516-3873930
Received: March 20, 2017
Peer-review started: March 23, 2017
First decision: May 3, 2017
Revised: August 2, 2017
Accepted: November 9, 2017
Article in press: November 9, 2017
Published online: February 6, 2018
ARTICLE HIGHLIGHTS
Background
The SONIC trial demonstrated the superiority of combination immunomodulator and biologic therapy for Crohn’s disease (CD). Further studies evaluated the efficacy of combination therapy (CT) in ulcerative colitis. There are concerns regarding the safety of CT, specifically the risks of infection and malignancy.
Research frontiers
Little is known about the degree of utilization of CT in the community setting. It is also unknown whether the publication of the SONIC trial impacted rates of CT usage.
Innovations and breakthrough
This study demonstrates that the utilization of CT has generally trended down over the past decade. It also demonstrates that the publication of the SONIC study did not lead to an increase in the utilization of CT.
Applications
The decline in CT utilization highlights the need for further studies to define the ideal patient population for CT, as well as the need for more definitive guidelines from professional societies.
Terminology
Combination therapy refers to the concurrent use of an immunomodulator, such as azathioprine, with a biologic drug, such as infliximab, in the treatment of inflammatory bowel disease.
