Share Facebook
Crohn's Disease Forum » Books, Multimedia, Research & News » Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease


02-24-2014, 05:34 AM   #1
kiny
Senior Member
 
kiny's Avatar
 
Join Date: Apr 2011
Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease

http://www.gastrojournal.org/article...671-5/abstract

Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease

March 2014

Brian G. Feaganemail,John W.D. McDonaldRemo PanaccioneRobert A. Enns,
Charles N. BernsteinTerry P. PonichRaymond BourdagesDonald G. MacIntosh
Chrystian DallaireAlbert CohenRichard N. FedorakPierre ParéAlain BittonFred SaibilFrank AndersonAllan DonnerCindy J. WongGuangyong ZouMargaret K. VandervoortMarybeth HopkinsGordon R. Greenberg

Background & Aims

Methotrexate and infliximab are effective therapies for Crohn's disease (CD). In the combination of maintenance methotrexate-infliximab trial, we evaluated the potential superiority of combination therapy over infliximab alone.

Methods

In a 50-week, double-blind, placebo-controlled trial, we compared methotrexate and infliximab with infliximab alone in 126 patients with CD who had initiated prednisone induction therapy (15–40 mg/day) within the preceding 6 weeks. Patients were assigned randomly to groups given methotrexate at an initial weekly dose of 10 mg, escalating to 25 mg/week (n = 63), or placebo (n = 63). Both groups received infliximab (5 mg/kg of body weight) at weeks 1, 3, 7, and 14, and every 8 weeks thereafter. Prednisone was tapered, beginning at week 1, and discontinued no later than week 14. The primary outcome was time to treatment failure, defined as a lack of prednisone-free remission (CD Activity Index, <150) at week 14 or failure to maintain remission through week 50.

Results

Patients' baseline characteristics were similar between groups. By week 50, the actuarial rate of treatment failure was 30.6% in the combination therapy group compared with 29.8% in the infliximab monotherapy group (P = .63; hazard ratio, 1.16; 95% confidence interval, 0.62–2.17). Prespecified subgroup analyses failed to show a benefit in patients with short disease duration or an increased level of C-reactive protein. No clinically meaningful differences were observed in secondary outcomes. Combination therapy was well tolerated.

Conclusions

The combination of infliximab and methotrexate, although safe, was no more effective than infliximab alone in patients with CD receiving treatment with prednisone.
02-24-2014, 06:48 AM   #2
Amanda89
Senior Member
 
Amanda89's Avatar
 
Join Date: Nov 2013
Location: Paisley, Scotland

My Support Groups:
Thanks Kiny! Interesting how MTX with Infliximab isn't any more effective together, but Imuran and Infliximab are.
__________________
Medication
Pentasa 400mg
Azathioprine 125mg
Cyclosporine

Past Medications
Prednisolone, Methotrexate oral & injections, Budesonide, Omeprazole, Asacol, Infliximabl
02-24-2014, 08:48 AM   #3
nogutsnoglory
Moderator
 
nogutsnoglory's Avatar
 
Join Date: Sep 2009
Location: New York

My Support Groups:
I wonder if this will move doctors in a new direction against this. Id like to get off MTX.
02-25-2014, 05:29 PM   #4
durwardian
Senior Member
 
durwardian's Avatar
If the doctors would pay attention to the latest data...
05-19-2014, 02:56 AM   #5
Crohn2357
Senior Member
 
Crohn2357's Avatar
 
Join Date: Aug 2013

My Support Groups:
I think the main reason for them being prescribed together is not making the therapy more effective; but trying to prevent antibodies to infliximab. I know infliximab is a chimeric monoclonal antibody so duo therapy is helpful but what about human, humanized biologics like adalimumab, certolizumab, vedolizumab?
This one gives answers I guess; but I'm not fully sure:
http://www.crohnsforum.com/showthread.php?t=63541
05-19-2014, 04:48 AM   #6
theOcean
Moderator
 
theOcean's Avatar
 
Join Date: Jan 2014
Location: Toronto, ON, Canada

My Support Groups:
I think the main reason for them being prescribed together is not making the therapy more effective; but trying to prevent antibodies to infliximab. I know infliximab is a chimeric monoclonal antibody so duo therapy is helpful but what about human, humanized biologics like adalimumab, certolizumab, vedolizumab?
This one gives answers I guess; but I'm not fully sure:
http://www.crohnsforum.com/showthread.php?t=63541
That it was to prevent antibodies was what my GI told me when I went on Imuran in combination with Humira. Otherwise I always felt Imuran was more effective at maintaining remission rather than helping cause it.
__________________
Diagnosis: Fistulizing Crohn's, 2011 (originally Dx as Ulcerative Pancolitis)
Past Medication: Pentasa, Remicade, Prednisone, Imuran
Current Medication: Humira (biweekly), 100mg 6mp
Unrelated Medication: 36mg Concerta, 75mg Pregabalin
Currently: In remission!
05-20-2014, 05:53 AM   #7
nogutsnoglory
Moderator
 
nogutsnoglory's Avatar
 
Join Date: Sep 2009
Location: New York

My Support Groups:
This study shows that the combo was not more statically helpful at protecting against antibody development. The two drugs may help fight the condition though since you are introducing two big guns.
Reply

Crohn's Disease Forum » Books, Multimedia, Research & News » Methotrexate in Combination With Infliximab Is No More Effective Than Infliximab Alone in Patients With Crohn's Disease
Thread Tools


All times are GMT -5. The time now is 07:17 PM.
Copyright 2006-2017 Crohnsforum.com