IBD Journal Scan
Key articles from high impact journals in last month
Editorial Recommendations
OCT-2025
SONIC - Infliximab plus Azathioprine in CD
This randomized, double-blind trial compared infliximab, azathioprine, and their combination in 508 adults with moderate-to-severe Crohn’s disease who were biologic- and immunosuppressant-naïve. Participants received infliximab infusions, azathioprine tablets, or both for 30 weeks, with a blinded extension to week 50. At week 26, corticosteroid-free clinical remission was achieved in 56.8% of those on combination therapy, compared with 44.4% on infliximab alone and 30.0% on azathioprine alone, showing clear superiority of the combination approach. Mucosal healing rates were also highest in the combination group. The incidence of serious infections was low and similar across all groups. These findings demonstrate that combining infliximab with azathioprine yields significantly greater clinical and endoscopic remission than either drug alone in Crohn’s disease.
UC SUCCESS - Infliximab plus Azathioprine in UC
This randomized, double-blind study compared infliximab, azathioprine, and their combination in adults with moderate-to-severe ulcerative colitis (UC) who had not previously received anti–TNF therapy. Over 16 weeks, patients were given infliximab infusions, azathioprine tablets, or both. Corticosteroid-free clinical remission at week 16 was achieved by 39.7% of those on combination therapy, compared with 22.1% on infliximab and 23.7% on azathioprine alone, demonstrating the superiority of combination therapy. Mucosal healing was also higher with the combined regimen (62.8%) versus azathioprine monotherapy (36.8%). Serious infections were rare and comparable across groups. Overall, combining infliximab and azathioprine significantly improved clinical remission and mucosal healing compared with monotherapy in moderate-to-severe UC.
COMMIT - Infliximab plus Methotrexate in CD
This 50-week, double-blind, placebo-controlled trial assessed whether combining methotrexate with infliximab offers additional benefit over infliximab alone in Crohn’s disease (CD). A total of 126 patients recently started on prednisone were randomized to receive methotrexate (escalating to 25 mg/week) plus infliximab or placebo plus infliximab. Prednisone tapering began at week 1 and was completed by week 14. The primary outcome— prednisone-free remission maintained through week 50—showed no significant difference: treatment failure occurred in 30.6% of the combination group versus 29.8% with infliximab alone. Subgroup and secondary analyses confirmed the lack of added efficacy. Both regimens were well tolerated. Thus, methotrexate plus infliximab was safe but not superior to infliximab monotherapy in Crohn’s disease management.
DIAMOND - Adalimumab plus Azathioprine in CD
This prospective, open-label study compared adalimumab monotherapy with adalimumab plus azathioprine in biologic- and thiopurine-naïve patients with active Crohn’s disease. A total of 176 patients were randomized to receive adalimumab alone or in combination with azathioprine for 52 weeks. The primary endpoint—clinical remission at week 26—was achieved at similar rates in both groups (71.8% with adalimumab alone vs 68.1% with combination therapy). However, endoscopic improvement was significantly greater with the combination regimen (84.2% vs 63.8%). More patients discontinued combination therapy due to adverse effects. Overall, adding azathioprine to adalimumab did not improve clinical remission but enhanced mucosal healing, suggesting limited additive clinical benefit with increased side effects.
VEGA - Guselkumab plus Golimumab in UC
This multicentre, double-blind, proof-of-concept trial evaluated whether combining guselkumab (an IL-23 inhibitor) with golimumab (a TNF-α inhibitor) improves outcomes in moderate-to-severe ulcerative colitis compared to either monotherapy. Conducted across 54 global sites, adults with active UC (Mayo score 6–12) were randomized to receive guselkumab + golimumab, guselkumab alone, or golimumab alone. The primary endpoint was clinical response at week 12, defined by a ≥30% Mayo score reduction and rectal bleeding improvement. Combination therapy achieved a higher rate of clinical response and endoscopic healing compared with either monotherapy, with safety comparable across groups. These results demonstrate that dual inhibition of IL-23 and TNF-α may offer enhanced efficacy for patients with moderate-to-severe UC, supporting further evaluation of this novel therapeutic approach.
EXPLORER - Vedolizumab plus Adalimumab plus Methotrexate in CD
The EXPLORER phase 4, open-label study investigated a novel triple combination therapy— vedolizumab, adalimumab, and methotrexate—in biologic-naïve patients with newly diagnosed, moderate-to-high-risk Crohn’s disease (CD). Fifty-five participants received vedolizumab and adalimumab per standard induction and maintenance schedules plus weekly methotrexate for 26 weeks. Endoscopic remission (SES-CD ≤2) at week 26 was achieved by 34.5% of patients, while clinical remission occurred in 61.8% at week 10 and 54.5% at week 26. Bayesian analyses indicated a higher probability of endoscopic remission with triple therapy versus placebo or monotherapy. Six serious adverse events were reported. These findings suggest that early, intensive triple biologicimmunomodulator therapy can achieve meaningful remission rates and may help overcome the efficacy ceiling seen with monotherapy in Crohn’s disease.
VETO - Vedolizumab plus Tofacitinib in UC
This prospective study evaluated the efficacy and safety of vedolizumab plus tofacitinib (VETO) combination therapy in patients with refractory ulcerative colitis (UC) unresponsive to anti-TNF agents and resistant to either drug alone. Among 91 patients with moderate-to-severe UC, non-responders to vedolizumab (n=14) or tofacitinib (n=15) were transitioned to combination VETO therapy and followed for 24 weeks. By week 24, clinical response and corticosteroid-free remission were achieved in 17 and 14 patients, respectively, with 7 attaining endoscopic remission. Mayo scores improved significantly, and no severe adverse events occurred. Two cases of pseudomembranous colitis resolved with treatment. Overall, VETO therapy demonstrated encouraging efficacy and a favorable safety profile in difficult-to-treat UC patients unresponsive to existing advanced therapies.