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Use of combination therapy in IBD

Over the past 2 decades many different drugs have been shown to be effective in the medical management of Crohn’s disease (CD) and ulcerative colitis (UC). The armamentarium of medications has evolved from 5-aminosalicylate (5-ASA) and corticosteroid preparations to immunomodulators and, more recently, biologicals targeting specific components of the immune cascade. As new medications are introduced monotherapy is usually the rule as physicians become comfortable with the balance between efficacy and toxicity. Combining therapies may lead to increased efficacy and even reduce or limit toxicity. An increase in toxicity by combining therapies will remain a realistic concern. By combining different medications clinicians have become more sophisticated in the way the inflammatory bowel diseases (IBDs) are treated. This chapter will explore the advantages and disadvantages associated with combining steroids, azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate (MTX), infliximab, 5-ASA preparations, and antibiotics in the treatment of CD and UC.