infliximab + thiopurines

Infliximab + thiopurines is a combination therapy used primarily in the treatment of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Infliximab is a chimeric monoclonal antibody that targets tumor necrosis factor-alpha (TNF-α), thereby disrupting pro-inflammatory signaling pathways. Thiopurines—such as azathioprine or 6-mercaptopurine—are immunomodulatory small molecules that antagonize endogenous purines and incorporate into cellular RNA/DNA to inhibit lymphocyte proliferation and induce T cell apoptosis. The combination is more effective than either agent alone for inducing and maintaining remission in IBD, largely due to reduced formation of anti-infliximab antibodies (anti-drug antibodies) which can neutralize the biologic agent. However, this increased efficacy comes with higher risks of adverse effects such as leukopenia, infections, and lymphoma.