Azathioprine and Infliximab: Monotherapy or Combination Therapy in the Treatment of Crohn's Disease

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract often resulting in complications resulting in decreased quality of life. Several classes of medications are available to clinicians including mesalamine, budesonide, systemic corticosteroids, thiopurine derivatives, and monoclonal antibodies which target tumor necrosis factor (TNF). Guidelines generally recommend reserving TNF-antagonists for patients who have failed other first-line therapies; however, emerging data suggests there may be some benefit in combining TNF-antagonists, specifically infliximab, with azathioprine. The purpose of this review is to compare the benefits and risks of combination therapy, and identify patients who may benefit most from this approach.