Which combination is commonly used as second-line therapy for ulcerative colitis when initial therapy fails?

Which combination is commonly used as second-line therapy for ulcerative colitis when initial therapy fails?

• A. Mesalamine and Sulfasalazine
• B. Prednisone and Methotrexate
• C. Budesonide and Azathioprine
• D. Azathioprine and Infliximab

Answer: (D)

When ulcerative colitis doesn’t respond to initial therapy, the goal is to induce remission and then maintain it with steroid-sparing strategies. A common second-line approach is to combine an immunomodulator with a biologic. Azathioprine helps keep the disease in remission and reduces the need for steroids, while infliximab, a TNF-alpha inhibitor, rapidly induces remission and promotes mucosal healing in moderate-to-severe disease. Using them together also lowers the risk that the infliximab will be neutralized by antibodies, improving long-term effectiveness. The other options rely on either first-line agents or less routinely used combinations for this scenario, so they don’t fit the standard escalation approach as well as the azathioprine and infliximab pairing.

When ulcerative colitis doesn’t respond to initial therapy, the goal is to induce remission and then maintain it with steroid-sparing strategies. A common second-line approach is to combine an immunomodulator with a biologic. Azathioprine helps keep the disease in remission and reduces the need for steroids, while infliximab, a TNF-alpha inhibitor, rapidly induces remission and promotes mucosal healing in moderate-to-severe disease. Using them together also lowers the risk that the infliximab will be neutralized by antibodies, improving long-term effectiveness.

The other options rely on either first-line agents or less routinely used combinations for this scenario, so they don’t fit the standard escalation approach as well as the azathioprine and infliximab pairing.