Top-Down Treatment Superior for Crohn Disease

One-year outcomes better with early combined infliximab + immunomodulator vs. accelerated step-up treatment
Top-Down Treatment Superior for Crohn Disease
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Medically Reviewed By:
Mark Arredondo, M.D.

TUESDAY, March 5, 2024 (HealthDay News) -- Top-down treatment for Crohn disease (combination infliximab plus immunomodulator) achieves substantially better outcomes than accelerated step-up treatment, according to a study published online Feb. 22 in The Lancet Gastroenterology & Hepatology.

Nurulamin M. Noor, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues evaluated the use of a putative prognostic biomarker to guide Crohn disease therapy. The analysis included patients randomly assigned to either top-down (189; i.e., early combined immunosuppression with infliximab and immunomodulator) or accelerated step-up (190; conventional) treatment strategies.

The researchers found no biomarker–treatment interaction effect (absolute difference, 1 percentage point; 95 percent confidence interval, –15 to 15). In the top-down group, sustained steroid-free and surgery-free remission were significantly more frequent than in the accelerated step-up group (79 versus 15 percent). The top-down group also had fewer adverse events (including disease flares) and serious adverse events versus the accelerated step-up group (adverse events: 168 versus 315; serious adverse events: 15 versus 42), including fewer complications requiring abdominal surgery (one versus 10). There were no differences in serious infections (three versus eight).

"Top-down treatment should be considered standard of care for patients with newly diagnosed active Crohn's disease," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text

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