In the SONIC trial for moderate-to-severe Crohn's disease, which treatment strategy showed superior rates of steroid-free clinical remission at week 26 compared with azathioprine monotherapy or infliximab monotherapy?
- A Infliximab plus azathioprine combination therapy ✓
- B Vedolizumab plus azathioprine
- C Ustekinumab plus methotrexate
- D Adalimumab monotherapy
Correct answer: A. Infliximab plus azathioprine combination therapy
Explanation
The SONIC trial (2010) demonstrated that combination therapy with infliximab plus azathioprine achieved steroid-free remission in 56.8% versus 44.4% for infliximab alone and 30% for azathioprine alone at week 26. The combination also prevented immunogenicity (anti-drug antibodies to infliximab) by azathioprine's immunomodulatory effect, improving drug trough levels. This established combination immunosuppression as the standard for moderate-to-severe Crohn's in biologic-naive patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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