azathioprine + adalimumab + infliximab

This is a combination therapy consisting of three drugs—azathioprine, adalimumab, and infliximab—used primarily in the management of inflammatory bowel disease (IBD), particularly Crohn's disease and ulcerative colitis. Azathioprine is an immunosuppressant (thiopurine class) that inhibits purine synthesis, thereby reducing lymphocyte proliferation. Adalimumab and infliximab are monoclonal antibodies targeting tumor necrosis factor alpha (TNF-α), a key cytokine involved in inflammation. The rationale for combining these agents is to optimize clinical remission rates, reduce immunogenicity against biologics (especially anti-TNF agents), and maintain higher drug trough levels. While dual combinations such as azathioprine plus either infliximab or adalimumab are well-studied—with evidence supporting improved outcomes over monotherapy—the simultaneous use of all three drugs together is not standard practice due to increased risk of adverse events and limited data on triple therapy efficacy or safety[2][4][5][7].