Raising doubts about Crohn’s treatment

The conventional drug regimen prescribed for people with Crohn’s disease might not be the best strategy, a new study shows.

Crohn’s disease is marked by inflammation and ulcers in the intestines. It has no cure, but patients often get relief from corticosteroids, such as prednisone, the standard medication for flare-ups. If those don’t work, doctors frequently turn to the anti-inflammatory drug infliximab (Remicade) and a slow-acting immune suppressor called azathioprine.

Although steroids are the standard first choice, they have side effects that include weight gain, easy bruising, swelling, and even osteoporosis.

To test whether the treatment order should be reversed, researchers randomly assigned 65 people in the throes of a Crohn’s attack to get the infliximab-azathioprine combination first. If patients hadn’t recovered after several weeks or months doctors prescribed steroids, depending on an individual’s status.

A group of 64 other Crohn’s patients received the conventional treatment—steroids first, followed later by the other two drugs only if needed.

After 6 months, 60 percent of those who initially received infliximab and azathioprine were free of Crohn’s disease symptoms, while only 36 percent of those getting steroids first were. This difference held up through 1 year, researchers report in the Feb. 23 Lancet.

Infliximab neutralizes an inflammation-causing protein called tumor necrosis factor alpha. This protein regulates “a common inflammation pathway that just happens to be important in Crohn’s disease,” suggests study coauthor Geert D’Haens, a gastroenterologist at Imelda General Hospital in Bonheiden, Belgium.

Results due out later this year from a larger study might clarify whether the standard treatment for Crohn’s patients should change, he says.

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