One-year outcomes better with early combined infliximab + immunomodulator vs. accelerated step-up treatment<\/p>\n<\/h3>\n
By Lori Solomon HealthDay Reporter<\/b><\/p>\n
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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\u00a0The Lancet Gastroenterology & Hepatology<\/em>.<\/p>\n 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.<\/p>\n The researchers found no biomarker\u00e2\u0080\u0093treatment interaction effect (absolute difference, 1 percentage point; 95 percent confidence interval, \u00e2\u0080\u009315 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).<\/p>\n “Top-down treatment should be considered standard of care for patients with newly diagnosed active Crohn’s disease,” the authors write.<\/p>\n Several authors disclosed ties to the pharmaceutical industry.<\/p>\n