It's crazy how treatment can be so different from one GI to another. This makes it so much harder when decisions have to be made re a treatment option!
S's ped GI barely ever mentioned any treatment other than supplemental EN, the most that he ever said was that he'd consider mtx after he saw test results but, apparently, results were good enough that he never added mtx (and this was when MRIs showed inflammation! but he had no clinical symptoms). Perhaps, because we were only with ped GI for 14 months before he was transferred to adult GI, the ped hesitated starting a treatment knowing he'd soon be seeing a new GI?? (Transfer was very defined at the children's hospital, the day you turn 18 you are transferred from children's to adult.)
Adult GI wanted remi and he never mentioned combination therapy. To be honest, even knowing the risk of antibody development, I never asked if combination treatment should be considered because I was stressed enough about remi without worrying about two meds...
Although I did ask about immunosuppressants instead of remi and his response was that he felt remi was the better treatment option so why not go with the better option (clearly a top down preference).
My aunt, in Europe, had a really, really tough time getting into remission after being diagnosed. Eventually, she was given remicade along with imuran and low dose steroids; she was one of the first patients to receive remicade in the region/country. She was kept on remi for only one year and, since then, has continued with only imuran and low dose steroids. This took her into remission and she's stayed in remission for probably close to 20 years now. To me, the fact that she needs steroids daily and periodically needs to adjust her dose for a week or two, it doesn't seem that she's ever been in deep remission?? but, throughout this time, she's certainly been well enough to live a completely normal life (with some diet adjustments).