Comparaison de l’efficacité du méthotrexate et de l’azathioprine dans le cadre d’une combothérapie, en association à un anti-TNF-α, chez des patients atteints d’une maladie inflammatoire chronique de l’intestin
- Authors
- Publication Date
- Sep 21, 2020
- Source
- HAL-Descartes
- Keywords
- Language
- English
- License
- Green
- External links
Abstract
Anti-TNFα treatments are effective in inducing and maintaining clinical remission and mucosal healing of inflammatory bowel disease (IBD). The addition of an immunosuppressant (combination therapy) is more effective as compared to an anti-TNFα monotherapy, particularly for the azathioprine-infliximab combination. However, the choice of the immunosuppressant remains an open question. Our study aims to compare the efficacy of methotrexate (MTX) and azathioprine (AZA) in combination with anti-TNFα in patients with IBD. Methods: all data regarding IBD patients treated with combination therapy (adalimumab or infliximab associated with AZA or MTX) within two centers between october, 2012 and november, 2019 were extracted. The primary endpoint was defined by the occurrence of clinical (absence of clinical symptoms of activity) and biological (normal CRP) remission within one year of the onset of combination therapy. Results: of the 348 patients in combination therapy included, 57 (16%) patients were on MTX and 291 (84%) patients were on AZA. The most commonly used anti-TNFα was infliximab (74%). Among the 348 patients, 213 (61%) patients were previously exposed to an immunosuppressant and 195 (56%) patients to an anti-TNFα. In the year following the onset of combination therapy, 68% of the AZA group (197 patients) and 60% of the MTX group (34 patients) achieved clinical and biological remission (p=0.18). Anti-TNFα drug survival (reflecting both drug efficacy and tolerance) did not differ between groups. In multivariate analysis, infliximab use was characterized by a higher drug survival (HR=1.57, p=0.02). Conclusion: combination therapy with MTX appears to be as well tolerated and effective for clinical and biological remission as combination therapy with AZA.
