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Combining new drugs with different mechanisms

ECCO 2018

As IBD is a mechanically complex disease characterised by a high heterogeneity, it is highly unlikely that one treatment will be sufficient.

Combinations of drugs can lead to a numerically greater efficacy (albeit with more serious adverse events (AEs)), for example when etanercept (anti-TNF agonist) and abatacept (CTLA-4-agonist) have been combined [1]. The same is true when an anti-TNF (etanercept/adalimumab) is combined with anti-CD20 (rituximab) [2]. However, the combination of etanercept and anakinra (IL-1 receptor antagonist) showed no greater efficacy, whilst there were no serious infections with etanercept [3].

The EXPLORER study aims to determine the effect of triple combination therapy on endoscopic remission in participants. It combines an anti-integrin (vedolizumab IV), TNF antagonist (adalimumab SC), and IMM (oral methotrexate). Newly-diagnosed CD patients are stratified at higher risk for complications [4]. Moreover, there are various approaches ...

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