Treating newly-diagnosed Crohn's patients with advanced therapy leads to dramatic improvements in outcomes

Medical Xpress / University of Cambridge / The Lancet Gastroenterology & Hepatology ^ | Feb. 22, 2024 | Dr. Nuru Noor et al

[ConservativeMind]

A large-scale clinical trial of treatment strategies for Crohn's disease has shown that offering early advanced therapy to all patients promptly after diagnosis can drastically improve outcomes, including by reducing the number of people requiring urgent abdominal surgery for treatment of their disease by ten-fold.

A "top-down" treatment strategy involving use of the drug infliximab straight after diagnosis showed dramatic results.

Infliximab works by blocking a protein found in the body's immune system, TNF (tumor necrosis factor)-alpha, which plays an important role in inflammation.

In the PROFILE trial, patients were assigned at random to one of two treatment groups.

The first group was treated using a conventional treatment strategy ("accelerated step-up"). In this group, patients only started on infliximab if their disease was progressing and not responding to other simpler treatments.

The second group, however, was treated with infliximab as soon as possible ("top-down strategy") after their diagnosis, regardless of the severity of their symptoms.

The results were dramatic: 80% of people receiving the top-down therapy had both symptoms and inflammatory markers controlled throughout the course of the entire year compared to only 15% of people receiving the accelerated step-up therapy.

Two-thirds (67%) of patients in the top-down group had no ulcers seen on their endoscopy camera test at the end of the trial—something known as endoscopic remission. Endoscopic remission is considered very important as this has been consistently associated with decreased risk of later complications in Crohn's disease. Most previous clinical trials of therapies have been considered highly successful based on getting 20 to 30% of patients into endoscopic remission.

As well as these findings, patients in the top-down arm also had higher quality of life scores, less use of steroid medication and lower number of hospitalizations.

[ConservativeMind]

This is a sizable change, but it would be a non-standard approach that would require coordination with the insurance company.

[ConservativeMind]

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[telescope115]

I wonder if it would work for UC. Maybe doing trials for that is next. The wheels of medicine, just like the wheels of justice, move slowly.

[FamiliarFace]

A friend of mine was recently diagnosed with Crohn’s. She’d never had the first symptom until soon after her first CoVid vaccine. She did have two of them, but no boosters. Maybe it doesn’t prove anything, but she seems pretty certain about it. I’ll pass this on to her.