Crohn's Disease: Immune Therapy First?

Remission from Crohn's disease may be more likely if patients get
immune-suppressing drugs , not steroids, first.

That news, published in the Feb. 23 edition of The Lancet, comes from
a study of Crohn's disease patients in Europe.

The study shows better remission rates when patients started their Crohn's
disease treatment with certain immune-suppressing drugs instead of
steroids.

"Our study clearly demonstrated that this alternative treatment method
was more effective at inducing disease remission than the conventional
method," says Brian Feagan, MD, in a news release.

"Not only were patients more likely to get their disease under control,
but they were also spared exposure to steroids -- the extended use of which is
linked with metabolic disease and even increased mortality," says Feagan,
who directs clinical trials at the Robarts Research Institute at Canada's
University of Western Ontario.

Other researchers are testing the same strategy. If their findings,
expected later this year, are in line with those from the European study,
"the treatment algorithm for patients with Crohn's disease will
change," sates an editorial in The Lancet.

Crohn's Disease Treatments

The European study included 133 Crohn's disease patients who hadn't started
taking any Crohn's disease medications.

The researchers randomly assigned half of the patients to start Crohn's
disease treatment by taking two immune-suppressing drugs, Remicade and Imuran.
Those patients could later take corticosteroids, if needed.

For comparison, the other patients got standard Crohn's disease treatment,
which involved first taking corticosteroids, then taking Imuran, and finally
taking Remicade.

The goal of the study was to see which group had better remission rates
without surgery after 26 weeks of treatment and after a year of treatment.

Crohn's Study Results

Remission rates were superior among patients who started treatment with
Remicade and Imuran.

Among those patients, 60% were in remission after 26 weeks of treatment and
nearly 62% were in remission one year after treatment started.

In comparison, about 36% of patients who started with steroid treatment were
in remission after 26 weeks of treatment and 42% were in remission one year
after treatment started.

After the first year of treatment, the two groups had similar remission
rates. Relapse happened later for patients who started with Remicade and
Imuran than those who started with steroids.

Shifting the Course of Crohn's?

Patients who started with Remicade and Imuran were less likely to have
ulcers after two years of treatment, compared with those who started with
steroids. In light of that pattern, the researchers suggest that starting with
Remicade and Imuran may change the course of the disease.

Both groups had a similar percentage of patients with side effects, note the
researchers.

The study was funded in part by Centocor, which makes Remicade, and
Schering-Plough, which markets Remicade outside the U.S. In The Lancet,
several researchers -- but not Feagan -- report financial ties to those and
other drug companies.

An editorial published with the study states that the findings "are not
sufficient" to assess serious side effects and that the data are
"insufficient to change clinical practice."

But all that could change if another trial, which is still under way, echoes
the European results, notes editorialist William Sandborn, MD, of the
Inflammatory Bowel Disease Clinic at the Mayo Clinic in Rochester, Minn.

The unfinished trial is called the Study of Biologic and
Immunomodulator Naive Patients in Crohn's Disease, or the SONIC trial. Sandborn
is working on that study, which Centocor and Schering-Plough are funding.

By Miranda Hitti
Reviewed by Louise Chang
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