People Newly Diagnosed with Crohn’s Disease Fare Much Better Starting with an Advanced Treatment

Starting on infliximab right after diagnosis leads to better outcomes than waiting longer for this medication, a new study suggests.

man starting early IV treatment with infliximab
Infliximab is given by infusion in a hospital setting.iStock

People newly diagnosed with Crohn’s disease who immediately start treatment with the injected drug infliximab (Remicade) may find it easier to manage their symptoms than people who wait longer to take this drug, a new study suggests.

For the study, researchers randomly assigned 386 people just diagnosed with Crohn’s disease to either: follow the typical standard of care, like starting treatment with anti-inflammatory drugs such as corticosteroids; or to right away start taking infliximab, an injected medicine that’s often reserved for people who don’t do well with standard care.

After one year, 80 percent of people who received infliximab right after their diagnosis were in remission based on lab tests showing a significant reduction in inflammation, compared with just 15 percent of patients who received standard care, according to study results published in The Lancet Gastroenterology and Hepatology.

“As soon as a patient is diagnosed with Crohn’s disease, the clock is ticking — and has likely been ticking for some time — in terms of damage happening to the bowel, so there’s a need to start on an advanced therapy such as infliximab as soon as possible,” said lead study author Nurulamin Noor, PhD, of the department of medicine at the University of Cambridge in England, in a?statement.

Treating Earlier With Infliximab Leads to Better Crohn’s Management

Traditionally, people who started taking infliximab any time within the first two years after diagnosis were considered “early” users of this drug for Crohn’s disease, Dr. Noor said in the statement. “We’ve shown that by treating earlier, we can achieve better outcomes for patients,” Noor added.

Crohn’s disease is a type of inflammatory bowel condition that causes swelling and tissue damage in the digestive tract. Symptoms can include abdominal pain, diarrhea, fatigue, anemia, and weight loss, as well as damage in the gastrointestinal tract that requires surgery to repair. In rare instances, Crohn’s symptoms can lead to potentially life-threatening complications such as rupturing of the intestines or colon cancer.

Infliximab is in a family of medicines known as tumor necrosis factor (TNF) blockers that work by halting activity of TNF, a protein involved in causing inflammation. Because this drug carries an increased infection risk, doctors often try other medicines for Crohn’s disease before considering infliximab.

However, there wasn’t a significant difference in the risk of infection for the people in the new study who started infliximab right after their diagnosis, compared with those who received standard care.

Scientists also found infliximab more effective than standard care based on more than just lab tests measuring markers of inflammation.

Starting Infliximab Immediately for Crohn’s Resulted in Endoscopic Remission

Researchers used cameras known as endoscopes to examine the digestive tract after a year of treatment and observed that 67 percent of people who took infliximab achieved what’s known as endoscopic remission, or no visible sores.

Researchers also found that people on inflixmab reported less disruption to their quality of life after their Crohn’s disease diagnosis and fewer hospitalizations over their first year of treatment. Less than 1 percent of people on inflixmab required urgent abdominal surgery, compared with about 5 percent of those on standard care.

“This study shows what a dramatic difference early treatment with advanced therapy can make to newly-diagnosed patients,” said Ruth Wakeman, director of services, advocacy, and evidence at Crohn’s and Colitis UK, in the statement.

“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,” Wakeman said. “Anything that speeds up the path to remission can only be a good thing.”

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  1. Noor N et al. Biomarker-Stratified Comparison of Top-Down Versus Accelerated Step-Up Treatment Strategies for Patients With Newly Diagnosed Crohn's Disease (Profile): A Multicentre, Open-Label Randomised Controlled Trial. The Lancet Gastroenterology and Hepatology. February 22, 2024.
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