Stronger drugs for Crohn's disease patients earlier could cut future risk, Cambridge study finds
One health expert has described the findings as "striking"
Giving people living with Crohn's disease stronger treatments sooner after they've been diagnosed could reduce the risk of complications in future, a Cambridge study has found.
Under current guidance, people with the disease usually start advanced treatment once they have more severe symptoms and disease complications.
But evidence from a trial led by Addenbrooke's Hospital supports an approach known as ‘top-down’ treatment where patients start on advanced biologic medications such as infliximab or adalimumab, as soon as possible after diagnosis.
Chris Dromgoole from Newmarket in Suffolk took part in the trial after being diagnosed with Crohn’s disease in late 2021.
"My symptoms improved almost as soon as the treatment started, I haven’t spent any time in hospital and I’ve had next to no problems," he said.
"You hear a lot of stories about the complications of Crohn’s disease and I hope the results of the trial will help more people to avoid them.”
What did the trial find?
The Profile trial included 389 adults newly diagnosed with Crohn’s across 40 UK hospitals.
Some were given infliximab plus an immunosuppressant from diagnosis as part of the “top down” approach, while others were assigned to a “step up” group where treatment progressed as symptoms worsened.
The study found that the need for surgery was five times lower among those were were given biologics earlier.
More than a third of those in the step up group were admitted to hospital compared to nearly a quarter who were on biologics soon after diagnosis.
“The findings are striking," Professor Miles Parkes, consultant gastroenterologist at Addenbrooke’s Hospital, said.
“The data from Profile now clearly show that early ‘top-down’ anti-TNF therapy from diagnosis is more effective and safer over both the short and long term, and saves money for the NHS and healthcare systems.
“These findings will change treatment for people newly diagnosed with Crohn’s disease around the world.”
When are biologics given to patients?
Crohn’s disease is a type of inflammatory bowel disease which causes symptoms such as diarrhoea and stomach pain.
Biologics are protein-based drugs that work by blocking the triggers of inflammation and are more precise than medicines that suppress the immune system.
However, they are not usually offered as an initial treatment following a Crohn’s diagnosis, with many patients starting with conventional therapies.
People usually move on to biologics if their disease is severe or other treatments stop working or cannot be tolerated.
“These long-term findings from Profile help to answer one of the most important questions that people have been asking for decades," Dr Nurulamin Noor, clinical lecturer in gastroenterology and first author of the trial, said.
"Is it possible to modify the course or alter the natural history of Crohn’s disease?
“Our data provide perhaps the most compelling evidence to date, that this can be achieved, by offering early effective therapy to patients – as soon as possible after diagnosis.”
Marianne Radcliffe, chief executive of Crohn’s & Colitis UK, said the trial shows the difference that advanced treatment can make to people who've just been diagnosed with Crohn's disease.
“Being told you have a lifelong condition is a lot to take on board and it is vital that patients are involved in decisions about their care," she added.
“No-one knows the daily reality of Crohn’s or colitis better than the person living with it.
“Having access to safe, effective drugs is a real positive so that patients everywhere can benefit from these research findings.”