New Treatment Scheme For Crohn’s Disease Changes The Outcomes
New research shows that Crohn’s disease patients treated early with biological therapy respond better to treatment and lesser need surgery . Crohn’s disease, or terminal ileitis, is an incurable disease, inflammatory, which can occur anywhere along the digestive tract. Unlike other inflammatory diseases, Crohn’s disease can affect only segments of the digestive tract and can be a starting point for adenocarcinoma. Specific for Crohn’s disease is its transmural nature and forming of granulomas. Clinically, this disease is characterized by fever, abdominal pain, weight loss. There may be complications such as fistulae, abscesses, anal and perianal, toxic megacolon. The cause of this disease is not fully known, although it was associated with other diseases, such as erythema nodosum, arthritis, uveitis, pyoderma gangrenosum.
Currently Crohn’s disease treatment consists of oral aminosalicylates or 5-ASA acid derivatives, corticosteroids, immunosuppressive or immunomodulatory agents and antimicrobial agents. In mild or moderate disease, the combination of aminosalicylates with metronidazole is recommended. When the disease is moderate, the treatment consists of glucocorticoid therapy associated with azathioprine and in severe forms corticosteroid with cyclosporine is recommended. Therefore, treatment is graded according to severity of disease. Even if patients respond to treatment at a rate of 40-50%, most are operated due to complications like intestinal obstruction or fistula.
Dr. David Rubin, MD, associate professor of medicine and co-director of the University of Chicago’s Medicine inflammatory Bowel Disease Center, tried a new strategy to treat Crohn’s disease and reversed the order of treatment. He added that drugs used for Crohn’s early stages, ie aminosalicylates acid are not always effective and risk multiple side effects. Furthermore, steroids are ineffective on the long-term and have adverse effects such as infections. According to Dr. Rubin, doctors hesitate to prescribe immunosuppressant medication because on the one hand, it is more expensive, and on the other hand , they believe that immunosuppression therapy (prescribed generally last in Crohn’s disease) is dangerous. Moreover, he adds, the more are introduced later, the side effects will be worse because the digestive tract is too damaged to respond as it should to treatment.
Dr. Rubin and his colleagues analyzed during the study three groups of patients: those treated with step-up therapy (started treatment with aminosalicylates, or corticosteroids) those on immunosuppressive therapy before anti-TNF and those treated the first with anti-TNF. It was found that those treated early with anti-TNF had a better response to treatment and the need for surgery was low. “This is the first time we did the large assessment of the top-down strategy using early-TNF claims databases,” Rubin said.