P087 - SONIC: a randomized, double-blind, controlled trial comparing infliximab and infliximab plus azathioprine to azathioprine in patients with Crohn's disease naive to immunomodulators and biologic therapy

Colombel, J.F.; Rutgeerts, Paul; Reinisch, Walter; Mantzaris, Gerassimos J.; Kornbluth, A.; Rachmilewitz, D.; Lichtiger, Simon; DʼHaens, G; Diamond, Robert H.; Broussard, Delma L.; Hegedus, Ronald; Woude, Christien J. van der; Sandborn, W.J.

doi:10.1016/s1873-9946(09)60114-8

Cited by 39 publications

(39 citation statements)

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“…Although immunosuppressive drugs are globally less effective than anti-TNF in CD, inducing less clinical remission and less mucosal healing [15], the outcome after discontinuation of these drugs may help to imagine what would happen after anti-TNF cessation. In an observational GETAID study of relapse after azathioprine cessation in CD, it was shown that the longer the duration of remission under azatioprine, the lowest the risk of relapse was [16].…”

Section: Outcome After Immunosuppressor Discontinuationmentioning

confidence: 99%

Anti-TNF and Crohns Disease: When Should We Stop?

Louis¹,

Bélaïche²,

Reenaers

2010

CDT

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When to stop anti-TNF therapy in Crohn's disease (CD)? This is a very important question both for patients and physicians. There is no published evidence to clearly and definitely answer this question. However data on natural history of CD, long term safety of biologies, outcome after immunosuppressors (IS) cessation and some preliminary studies on biologies cessation may help us to discuss this topic. One could argue that there is currently no good reason to stop anti-TNF therapy in a patient who is in stable remission and can tolerate this drug very well. The decision to stop an anti-TNF treatment is thus currently based on a compromise between the benefits/risks and cost of such long term treatment. While it appears now clearly that prolonged anti-TNF therapy is associated with favourable outcome with sustained remission, reduced surgeries and hospitalisation as well as absence of significant increase in mortality or cancers, the cost-effectiveness which is probably favourable for short and mid-term treatment (up to one year), may be less optimal for very long term treatment. In this perspective however, prospective studies should be performed to adequately assess long term evolution, disease outcome, safety and global cost of strategies based on treatment reduction with IS maintenance alone or even full treatment cessation.

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Section: Outcome After Immunosuppressor Discontinuationmentioning

confidence: 99%

Anti-TNF and Crohns Disease: When Should We Stop?

Louis¹,

Bélaïche²,

Reenaers

2010

CDT

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“…A UC equivalent of the SONIC trial would be required to address these questions. 120 In patients with severe, or steroid-refractory UC, there are insufficient data to conclude whether iv infliximab or iv cyclosporine is the best approach. Cyclosporine is associated with higher initial response rates than infliximab, and at earlier time-points; 82% response within 7 days with cyclosporine, compared with 50% response at 2 weeks with infliximab.…”

Section: Discussionmentioning

confidence: 99%

Cause for controversy? Infliximab in the treatment of ulcerative colitis: an update

Lawlor

Moss

2009

CEG

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Infliximab is a monoclonal antibody against tumor necrosis factor (TNF) which has become an established therapy for Crohn's disease over the last 10 years. Given the similarities between Crohn's disease and ulcerative colitis (UC), it is no surprise that gastroenterologists have used infliximab in patients with UC who have failed other therapies. Although the initial controlled trials with infliximab in steroid-refractory disease were unimpressive, subsequent controlled trials have demonstrated the efficacy of infliximab in both moderate to severe disease, and as rescue-therapy to avoid colectomy. The long-term remission rates, colectomy-sparing effects, and the impact of concomitant immunomodulator therapy, remain to be determined in these patients. Whether infliximab is a superior strategy to cyclosporine in patients with steroidrefractory disease is controversial. This review examines the data on the efficacy and safety of infliximab as an induction and maintenance agent for UC.

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“…Higher response and healing rates were reported in a Canadian cohort of Crohn ' s disease patients treated with infl iximab when trough levels were detectable, regardless of the levels ( 13 ). In the recent SONIC trial, combined treatment with infl iximab and azathioprine was superior to azathioprine and infl iximab monotherapy for at least 1 year ( 14 ), results that were corroborated by the infl iximab trough levels that were almost double as high in the combined vs. in the monotherapy group.…”

mentioning

confidence: 85%

Anti-TNF Treatment in Crohn's Disease: Toward Tailored Therapy?

D’Haens¹

2010

American Journal of Gastroenterology

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Infl iximab is a potent therapy for induction and maintenance of remission in Crohn ' s disease. Unfortunately, many patients lose response and / or develop allergic reactions caused by the chimeric antibody. By means of measuring the presence of antibodies against infl iximab and the trough levels of the drug, it seems easier to predict whether patients will respond to intensifi ed dose regimens or will rather benefi t from a switch to alternative agents.

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P087 - SONIC: a randomized, double-blind, controlled trial comparing infliximab and infliximab plus azathioprine to azathioprine in patients with Crohn's disease naive to immunomodulators and biologic therapy

Cited by 39 publications

References 0 publications

Anti-TNF and Crohns Disease: When Should We Stop?

Anti-TNF and Crohns Disease: When Should We Stop?

Cause for controversy? Infliximab in the treatment of ulcerative colitis: an update

Anti-TNF Treatment in Crohn's Disease: Toward Tailored Therapy?

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