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While the treatment of Crohn’s disease undertaken often depends on the severity criteria of the patients, a new study demonstrates that treatment with biotherapy “as soon as” the diagnosis could reduce the need for surgery and other treatments. A major breakthrough that could change practice?
A chronic inflammatory disease of the digestive tract, Crohn’s disease currently affects 120,000 people in France. People whose treatment depends on the severity of the disease (especially flare-ups): corticosteroids, biotherapies reserved for advanced forms and sometimes surgery. But a new study suggests that the use of normal biotherapies from the outset from diagnosis could considerably reduce the need for surgery and future complications.
Entry biotherapy changes the future of patients
Researchers from the NIHR Cambridge Biomedical Research Center divided the 386 newly diagnosed patients in 40 hospitals across the United Kingdom into two groups. Half received conventional treatment while the other half were offered a “top-down” approach and received infliximab as soon as possible after their diagnosis, regardless of their symptoms. The effectiveness results were not long in coming.
- The majority (80%) of people taking infliximab saw their symptoms controlled for a year, compared to only 15% in the conventional group;
- About 67% of patients on infliximab also had no ulcers on endoscopy at the end of the trial;
- Approximately 5% of treated patients required conventional surgery, compared to 0.5% in the infliximab group.
For Professor Miles Parkes, chief investigator of the Profile trial, the process change is a major breakthrough: “Until now, the view has been ‘why use a more expensive treatment strategy and potentially overtreat people’.” But many studies have gradually shown that there is actually a fairly high risk that a person with Crohn’s disease will experience flare-ups and complications, even during the first year after diagnosis.
“We now know that we can prevent the majority of adverse outcomes, including the need for urgent surgery, by providing a safe and increasingly affordable treatment strategy.”
Changing the trajectory of the disease, from the start
For Anne Buisson, director at AFA Crohn RCH France, (national association of patients and relatives mobilized against Crohn’s disease and ulcerative colitis) contacted by Doctissimo, the discovery answers a question that the medical profession has been asking for 20 years around of Crohn’s disease.
“Since we have known about biotherapies, in short, we have wondered if by powerfully treating patients we will be able to change the natural history of the disease.”
But in reality, it is rather the opposite trend that is used: “Clinicians often ask themselves the question of which patients are going to be treated powerfully, which are those who have the worst score from the outset and who are at the greatest risk of complications. With the desire not to “overtreat” those who do not need it.”
Towards a change in care?
By including this time patients who have just been diagnosed, without classification of severity, the study provides new and original data according to it.
“Potentially, this answers the question of whether it should therefore be treated as soon as possible. It has the merit of demonstrating that in a cohort of patients, those who immediately receive infliximab will get better, regardless of the severity criteria. “
Data which ultimately underlines the importance of diagnosing the disease as quickly as possible in order to treat it without delay. “There is still a lot to do, but it is important for us to imagine that at some point there could be a practice that modifies the natural history of the disease. Maybe we’re there.”
If these results are confirmed, a change in care could take place, even if several questions remain unanswered: how long will the treatment with biotherapies have to be followed? What are the possible long-term side effects versus the reduction in complications linked to the disease?… The price of biotherapies could also constitute a barrier, it will have to be (re)evaluated with regard to the complications avoided and the quality of life preserved from patients. To be continued…