Hôpital universitaire de Nancy,
Université Henri Poincaré
1, Allée de Morvan,
Anti-tumor necrosis factor agents have become an integral component of the treatment algorithm for IBD. Despite the wealth of data available for these agents the optimal treatment approach remains unclear, particularly when considering the addition of an immunomodulator. The role of combination therapy represents a point of significant consternation for providers due to concerns surrounding the balance between safety and efficacy. This often leads to delays in treatment initiation which may impact disease outcomes and patient care. In this review we will summarize the currently available literature regarding the use of anti-TNF monotherapy versus combination therapy with an immunomodulator for IBD. Specifically, we will compare the safety and efficacy of these approaches in randomized controlled trials to observational “real life” studies. We will then discuss how these data can be applied to common clinical scenarios seen in practice. We anticipate this review will allow providers to better appreciate the outcomes to be expected with these approaches which will enhance the shared decision making process for patients facing this difficult decision.