Combination Therapy Treats Crohn's Disease
Study Shows Combination of Biologic and Immune-Suppressing Drugs Is Best Treatment for Crohn's
Combination Treatment for Crohn's: Risk, Cost
The treatment is not without risk. Remicade and other anti-TNF drugs (Humira and Cimzia) increase a patient's risk of life-threatening infections and cancers. So do immune-suppressing drugs, although the Remicade trial suggested that combination therapy is not more risky than azathioprine or Remicade alone.
In the study, 4% of patients receiving the Remicade/azathioprine combination developed serious infections, as did 5% of those in the Remicade-only group and 5.6% of those in the azathioprine-only group.
And the treatment is expensive. A 155-pound patient would need about 350 milligrams of Remicade per treatment. Four 100-milligram vials of Remicade cost $2,763, according to drugstore.com.
Other anti-TNF drugs, which Sandborn and Kerman say should work as well as Remicade, cost about as much. But Kerman notes that anti-TNF therapy for Crohn's disease is actually cost-effective, as the drugs prevent hospitalizations, loss of work, and other expenses.
"I'd like for Crohn's patients to ask their doctors to consider combination treatment with these biologics and immune modulators as an early therapy," Kerman says. "It has been shown that treating much earlier gives them a much better chance of responding, rather than getting the treatment after damage already has been done."
The combination therapy does not cure Crohn's disease. Treatment must continue indefinitely. However, Sandborn says that some of the patients in the earliest clinical trials are still doing well after 12 years of treatment.
Sandborn serves as a consultant to Centocor, which makes Remicade, and to Abbott, which makes Humira. Fees for this consultation go to Mayo Clinic and not directly to him. Kerman is on the speakers bureau for UCB, which makes the anti-TNF drug Cimzia.
Sandborn and colleagues report the finding of their trial in the April 15 issue of the New England Journal of Medicine.