Rationale for Correct Answer
The correct answer is: An anti-TNF-α and an immunomodulatory agent
For patients with moderate-to-severe CD or UC, treatment with a combination of anti-TNF-α therapy and an immunomodulator has greater efficacy than either monotherapy. Clinical guidelines recommend initiating anti-TNF-α therapy in combination with an immunomodulatory agent in patients with moderate-to-severe IBD, with the strongest recommendation being for the specific combination of infliximab and a thiopurine.3-6 For patients with a high risk of infections or who prefer not having an immunomodulator, anti-TNF-α monotherapy is a reasonable alternative.6,7 A phase 2 trial found some clinical benefits when the anti-TNF-α golimumab was combined with the IL-23 inhibitor guselkumab, compared with either therapy alone, but confirmation of this finding in larger-scale studies is needed.8
References:
1. Colombel JF et al. N Engl J Med. 2010;362(15):1383-95;
2. Panaccione R et al. Gastroenterology. 2014;146(2):392-400.e3;
3. Rubin DT et al. Am J Gastroenterol. 2019;114(3):384-413;
4. Lichtenstein GR et al. Am J Gastroenterol. 2018;113(4):481-517;
5. Feurstein JD et al. Gastroenterology. 2021;160(7):2496-2508;
6. Feurstein JD et al. Gastroenterology. 2020;158(5):1450-61;
7. Hashash J et al. Ann Gastroenterol. 2021;34(5):612-24;
8. Feagan BG et al. Lancet Gastroenterol Hepatol. 2023;8(4):307-20.