Effectiveness of combined therapy with Infliximab and Azathioprine in the management of Crohn's disease: A systematic review according to PRISMA guidelines

Abstract

Objective: Evaluate the efficacy of combined therapy with Infliximab and Azathioprine in Crohn's disease. Methodology: A
systematic review was conducted following PRISMA guidelines. Sixteen articles were searched in PubMed, Google Scholar,
and SciELO, applying inclusion and exclusion criteria, complemented with 3 through manual search. Results: Combined
therapy demonstrated significant benefits in 19 selected studies. In the SONIC trial, it outperformed monotherapy, achieving
higher clinical remission (56.8% vs. 44.4%) and mucosal healing (43.9% vs. 30.1%) at week 26. It reduced Infliximab
immunogenicity, increasing serum concentrations (3.5 mg/mL vs. 1.6 mg/mL). Other studies supported efficacy and safety,
showing lower clinical failure, reduced risk of hospitalization or surgery, and improvements in quality of life. Discussion: The research highlights the effectiveness of combined therapy, supported by multiple studies, including SONIC. Emphasis is
placed on its long-term impact, reducing adverse events and complications. Individualized management and overall safety are essential when considering this therapeutic strategy in Crohn's disease management. Reduction in immunogenicity
and sustainability of therapeutic response reinforce the position of combined therapy as a preferred option, providing
valuable insight for future research.