The Pharmaceutical Journal
Vol 280 No 7491 p240
1 March 2008

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Crohn’s patients may benefit from early intensive treatment

Intensive early treatment of Crohn’s disease could improve patient outcomes, a study suggests (Lancet 2008;371;660).

Researchers randomised 131 patients with active Crohn’s disease who had not previously received corticosteroids, antimetabolites or infliximab to be given either combined immunosuppression or conventional treatment.

Patients assigned combined immunosuppression received infliximab and azathioprine followed by maintenance with azathioprine. Patients assigned conventional treatment received sequential treatment with two tapering courses of corticosteroids, then azathioprine, and then infliximab. Patients intolerant of azathioprine in either group received methotrexate in its place.

At week 26, 60.0 per cent of patients in the combined immunosuppression group were in remission, compared with 35.9 per cent of controls (P=0.0062). At week 52, 61.5 per cent of the immunosuppression group were in remission, compared with 42.2 per cent of controls (P=0.0278).

The authors of an accompanying editorial (ibid, p635) say that the small scale of the study means that the comparative benefit of combined therapy, and the frequency of adverse events associated with it, may not have been accurately assessed.

However, they add, if the findings can be confirmed in a sufficiently large trial comparing azathioprine, a tumour-necrosis factor antagonist (such as infliximab) and the two combined, the treatment algorithm for patients with Crohn’s disease will need to be changed.