Finding appropriate timing for the combination of azathioprine and infliximab - propensity score matching and inverse probability of treatment weighting analysis

Q: What clinical problem does this study address?

The study addresses how to determine the optimal timing for AZA initiation in patients receiving IFX combination therapy for Crohn’s disease while balancing benefit and adverse-event risk.

Q: How were confounding factors handled?

Baseline differences were controlled using two propensity score approaches: propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).

Q: Did induction vs maintenance AZA timing lead to different outcomes?

After PSM or IPTW, remission rates at 54 weeks were similar between induction (IP-AZA) and maintenance (MP-AZA) starters, and safety profiles were comparable.

Sep 30, 2026

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Combination therapy with azathioprine (AZA) and infliximab (IFX) improves clinical efficacy in Crohn’s disease but increases the risk of adverse events. This retrospective single-center study evaluates the optimal timing for starting AZA alongside IFX to maximize patient benefit. Patients treated with IFX from January 2017 to December 2022 were analyzed using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Clinical remission at 54 weeks served as the primary efficacy endpoint, with adverse events assessed by systematic monitoring.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

Clinical and Experimental Medicine (2026) 26:77 [https://doi.org/10.1007/s10238-025-02007-0](https://doi.org/10.1007/s10238-025-02007-0) RESEARCH Finding appropriate timing for the combination of azathioprine and infliximab: propensity score matching and inverse probability of treatment weighting analysis Keke Tang1 · Yong Li1 · Ziheng Peng1 · Duo Xu1 · Yu Peng1 · Xiaowei Liu1,2,3,4 Received: 29 July 2025 / Accepted: 13 December 2025 © The Author(s) 2025 Abstract Background The combination of azathioprine (AZA) with infliximab (IFX) enhances clinical efficacy in treating Crohn’s disease (CD), increasing the risk of adverse events. This study aims to identify the optimal timing for AZA administration in IFX combination therapy to maximize patient benefit. Methods This was a retrospective, single-center study, which analyzed patients with CD undergoing IFX treatment from January 2017 to December 2022. Baseline data were collected. To minimize potential confounding effects, we utilized two established propensity score methods: propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). The primary efficacy outcome was defined as the proportion of patients achieving clinical remission at the 54-week follow-up. Safety outcomes were evaluated through comprehensive monitoring and systematic classification of adverse events. Results A total of 528 active CD patients were included. Of these, 146 received concomitant AZA (AZA group), while 382 did not (non-AZA group) . Following PSM or IPTW, the AZA group demonstrated significantly higher clinical remission rates (PSM: P< 0.001, IPTW: P< 0.001) compared to the non-AZA group. Furthermore, 46 patients used AZA during induction (IP-AZA group) and 100 during maintenance (MP-AZA group). After PSM or IPTW, both groups showed similar remission rates at 54 weeks (PSM: P = 0.793, IPTW: P = 0.508), with comparable safety profiles. Conclusion For CD patients treated with IFX, whether AZA was initiated in the induction phase or during the maintenance phase, the impact on clinical outcomes and occurrence of adverse events was similar. Keywords Azathioprine · Infliximab · Crohn’s disease · Combination therapy Keke Tang and Yong Li have contributed equally to this work. 􀀍 Yu Peng [pengyu918@csu.edu.cn](pengyu918@csu.edu.cn) 􀀍 Xiaowei Liu [liuxw@csu.edu.cn](liuxw@csu.edu.cn) 1 Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China 2 Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Artificial, Central South University, Changsha 410008, Hunan, China 3 Gut-Liver Axis and Intestinal Barrier Research Center, Xiangya Hospital, Central South University, Changsha 410008, China 4 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China Introduction Crohn’s disease (CD) is a chronic, progressive form of inflammatory bowel disease(IBD)characterized by recurrent episodes of inflammation that result in cumulative intestinal tissue damage over time [1].Prolonged use of traditional therapeutic drugs, such as corticosteroids, can result in the development of resistance and complications like Cushing’s syndrome, thereby increasing the risk of mortality [2]. The advent of biological treatments has the potential to mitigate the adverse effects of the disease and alleviate its symptoms [3] . Infliximab (IFX), a chimeric monoclonal antibody targeting tumor necrosis factor-α (TNF-α), represents one of the first-line biologic therapies for CD patients refractory to standard therapeutic interventions [4] . Clinical evidence demonstrates that IFX therapy not only induces 1 3 clinical remission but also significantly reduces surgical intervention rates and hospitalization requirements in this patient population [5] . However, the

FAQs

What clinical problem does this study address?

The study addresses how to determine the optimal timing for AZA initiation in patients receiving IFX combination therapy for Crohn’s disease while balancing benefit and adverse-event risk.

How were confounding factors handled?

Baseline differences were controlled using two propensity score approaches: propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).

Did induction vs maintenance AZA timing lead to different outcomes?

After PSM or IPTW, remission rates at 54 weeks were similar between induction (IP-AZA) and maintenance (MP-AZA) starters, and safety profiles were comparable.

Sep 30, 2026

Upload by Liam