Concomitant use of thiopurines in maintenance therapy for CD confers no clear benefit

Using thiopurines in combination with scheduled adalimumab monotherapy for longer than 6 months in the maintenance treatment of patients with Crohn’s disease (CD) does not appear to yield additional beneficial effect, according to data from the DIAMOND2 trial.

DIAMOND2 included 50 CD patients (mean age, 35 years; 20 percent female) in corticosteroid-free clinical remission (CFCR) for ≥6 months who were receiving thiopurines concomitantly with scheduled maintenance of adalimumab (40 mg every other week). These patients were randomized to either continue (n=22) or discontinue (n=28) thiopurines after 6 months of treatment. Adalimumab therapy lasted 52 weeks.

The primary endpoint of CFCR at week 52 did not significantly differ between the group of patients who continued and the group who discontinued thiopurines (95.5 percent vs 92.9 percent; p=1.000). The same was true for mucosal healing (30 percent vs 32 percent; p=1.000).

Similar results were also noted for trough levels of adalimumab (p=0.515) and the proportion of patients with antiadalimumab antibodies positivity (p=0.437) at week 52 in the two treatment groups. Endoscopic remission at baseline correlated with endoscopic and triple remission at week 52.

There were no serious adverse events reported in either group that continued or discontinued thiopurines therapy.  

The present data indicate that all patients who are in clinical remission do not necessarily need long-term use of thiopurines with adalimumab maintenance, according to researchers. This suggests that further consideration of the addition of thiopurine in maintenance therapy for CD is necessary from the viewpoints of benefit and risk.