{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:32:42Z","timestamp":1782826362085,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,5,3]],"date-time":"2017-05-03T00:00:00Z","timestamp":1493769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 DK097142"],"award-info":[{"award-number":["K23 DK097142"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The impact of combination therapy on disease\u2010related morbidity in patients with established Crohn's disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>) or ulcerative colitis (<jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content>) remains to be well\u2010defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To examine the effect of combination therapy on disease outcomes in CD and UC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a multicenter prospective cohort, we classified <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> patients as being on monotherapy with anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> or on combination with an immunomodulator. The primary outcome was a composite of new <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content>\u2010related surgery, hospitalisations, penetrating complications, need for corticosteroids or new biological at 1 year. Multivariable regression models adjusted for potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 707 patients with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (45% combination therapy) and 164 with <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> (38% combination therapy). Combination therapy was not associated with reduction in the composite outcome in either <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.87, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.63\u20101.22) or <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 1.45, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.63\u20103.38). However, while no difference was noted in those with nonstricturing, nonpenetrating <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>, a significant reduction in the likelihood of the outcome was seen in those with stricturing or penetrating <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (30% vs 39%, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.58, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.37\u20100.90). A stronger effect was also observed in those with disease duration &lt;5 years (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.35, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.14\u20100.87) compared to those with a longer duration (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.75, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.45\u20101.27). A similar reduction in occurrence of composite outcome was noted with infliximab and with other anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> biologics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The benefit of combination immunomodulator\u2010biological therapy is stronger in those with complicated Crohn's disease, particularly early on in their disease course.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14125","type":"journal-article","created":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T02:12:48Z","timestamp":1493863968000},"page":"162-168","source":"Crossref","is-referenced-by-count":14,"title":["The benefit of combination therapy depends on disease phenotype and duration in Crohn's disease"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9436-1821","authenticated-orcid":false,"given":"A. N","family":"Ananthakrishnan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Massachusetts General Hospital and Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-6129","authenticated-orcid":false,"given":"A.","family":"Sakuraba","sequence":"additional","affiliation":[{"name":"Inflammatory Bowel Disease Center and Division of Gastroenterology University of Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. L.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of North Carolina School of Medicine Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Pekow","sequence":"additional","affiliation":[{"name":"Inflammatory Bowel Disease Center and Division of Gastroenterology University of Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Raffals","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. D.","family":"Long","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of North Carolina School of Medicine Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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