Patients with IBD who develop an immune-modulated loss of response to their first anti-TNF agent may fare better on a second if they take azathioprine, researchers report.

French investigators randomised 90 patients, all of whom had lost response to their first anti-TNF, to either a second anti-TNF as monotherapy, or in combination with the immunosuppressant, azathioprine (2-2.5mg/kg/day).

Two years after switching to their second anti-TNF, patients on the combination with azathioprine had a survival rate, without clinical failure, of 77%, compared with 22% for those on monotherapy.

Similar results were seen for survival without pharmacokinetic failure, measured as undetectable trough levels of the biologic and high levels of antidrug antibodies, the investigators reported in Gut.