Early drug treatment leads to better outcomes for Crohn’s disease

Getting advanced treatment immediately after a Crohn’s disease diagnosis improves patient outcomes, according to a year-long study involving 386 people.

The disease is a life-long inflammatory bowel condition that affects millions of people around the world. Symptoms include stomach aches, diarrhoea, tiredness and weight loss.

“These symptoms massively impact people’s quality of life, their education, their relationships, their ability to work and so on,” says Miles Parkes at the University of Cambridge. “We don’t have any cures for it, but we do have some ways to mitigate some of these bad outcomes.”

Treatment often involves dietary changes, immunosuppressants and steroids. In the UK, a medication called infliximab – an antibody that targets specific proteins in the body thought to contribute to gut inflammation – can be prescribed to people who experience regular Crohn’s disease flare-ups or who haven’t responded to other, less-intense treatments.

“That’s a ‘step-up’ approach, where you reactively escalate treatment in response to disease flares,” says Nurulamin Noor, also at the University of Cambridge.

To see what would happen if this more-potent therapy was used as early as possible, Parkes, Noor and their colleagues recruited 386 people in the UK, all newly diagnosed with Crohn’s disease and between 16 and 80 years old.

They were split into two groups. The first received infliximab immediately regardless of their symptoms, while the other was treated with other Crohn’s disease medications. If their symptoms continued to persist or worsen, the participants in the second group would also be prescribed with infliximab, in line with the “step-up” approach.

After a year, 80 per cent of those who received infliximab from the get-go had managed to control their symptoms throughout the period, compared with just 15 per cent of those who didn’t get it immediately.

Additionally, just 0.5 per cent of people in the group that had infliximab straight away required abdominal surgery for Crohn’s disease compared with 4.5 per cent in the second group.

The findings suggest that giving people with Crohn’s disease strong treatment as soon as they get their diagnosis is more effective at improving their lives, says Noor.

The extra money spent on medication would also be balanced by not having to pay for scans, colonoscopies and surgery later on in people who continue to experience recurrent flare-ups, says Parkes.

“People with Crohn’s don’t want to be stuck in hospital or having surgery, they want to be out in the world, living their lives. Anything that speeds up the path to remission can only be a good thing,” says Ruth Wakeman at the charity Crohn’s & Colitis UK.