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BMJ 2010; 340 doi: (Published 22 April 2010) Cite this as: BMJ 2010;340:c2087

Infliximab looks a better second line option for Crohn’s disease

Young adults who don’t respond to first line treatments for Crohn’s disease are often started on azathioprine. A new trial suggests that infliximab works better. Both drugs together work better still, although the combination carries a risk of rare but serious side effects, say the authors.

The double blind double dummy trial comprised 508 adults with moderate or severe Crohn’s disease who were given infliximab, azathioprine, or both for up to 50 weeks. The chance of remission without the need for systemic steroids was 56.8% (96/169) in those given both drugs, 44.4% (75/169) in those given infliximab alone, and 30% (51/170) in controls given azathioprine. Infliximab was also better at healing mucosal ulcers than azathioprine. Again, the combination worked best. Findings were similar at 26 and 50 weeks.

These adults had had Crohn’s disease for a median of two years at randomisation. They had tried systemic steroids, budesonide, or mesalamine without success. None had received azathioprine or infliximab before the trial.

Side effect profiles were comparable in all three groups, and those given the combination had no more serious infections than others. But the trial was too small to rule out this kind of hazard. Combining azathioprine with biological agents against tumour necrosis factor (TNF) has already been linked to an excess of serious opportunistic infections and hepatosplenic T cell lymphomas.

Setback for CMV screening in newborns

Neonatal cytomegalovirus (CMV) infection is a leading cause of sensorineural deafness. Researchers looking for a rapid and reliable screening test had high hopes for the dried blood spots collected routinely for metabolic screening in many developed countries. Real time polymerase chain reaction (PCR) technology should, in theory, detect viral DNA in blood spots from infected newborns. But the test proved disappointingly inaccurate in the first large prospective study. A single primer test had a sensitivity of just …

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