Medication Review: Monotherapy vs. Combination Therapy: Relevance in IBD Treatment Strategy

Thank you to Celltrion for the support on this Medication Review Video Module.

This medication review explores the evolving role of monotherapy versus combination therapy in the treatment of inflammatory bowel disease (IBD), with a focus on biologic optimization and patient-centered treatment strategies. In this expert-led discussion, Brooke Hodnick, PA, from Texas Digestive Disease Consultants, reviews the clinical rationale behind combining biologic therapies such as infliximab with immunomodulators, including methotrexate and thiopurines, to reduce immunogenicity, improve biologic drug levels, and enhance long-term treatment outcomes in ulcerative colitis and Crohn’s disease. The presentation highlights pivotal clinical trials including SONIC and UC SUCCESS, which demonstrated improved remission rates and mucosal healing with combination therapy involving TNF inhibitors. Current recommendations from the American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) supporting infliximab combination therapy are also discussed.

The review also examines the growing interest in biologic monotherapy approaches, particularly with subcutaneous infliximab formulations. Data from the LIBERTY Crohn’s and LIBERTY UC trials are explored, demonstrating stable and sustained pharmacokinetic drug concentrations through two years of treatment without the need for additional immunomodulators. This PK-driven monotherapy strategy may help reduce long-term immunosuppressive burden while maintaining efficacy in select patients with IBD. Important safety considerations are addressed, including infection risk, lymphoma risk, hepatosplenic T-cell lymphoma, and non-melanoma skin cancer associated with thiopurine use, especially in older adults and younger male patients receiving prolonged combination therapy.

Learn how clinicians are balancing efficacy, safety, immunogenicity, and treatment simplification when selecting monotherapy versus combination therapy for ulcerative colitis and Crohn’s disease. This educational medication review provides practical insights for gastroenterology advanced practice providers and healthcare professionals managing complex IBD patients in clinical practice. Visit the GHAPP Website, GHAPP Digital Hub or GHAPP ACE app for additional educational content.