Early Combined Immunosuppression Treatment in Crohn’s Disease Found to Improve Disease Course

Early Combined Immunosuppression Treatment in Crohn’s Disease Found to Improve Disease Course

A new study recently published in the journal The Lancet revealed that early combined immunosuppression (ECI) treatment can improve the disease course in patients with Crohn’s disease. The study is entitled “Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial”, and was led by researchers at the Robarts Research Institute and the University of Western Ontario in Canada.

Canada is known to have one of the highest rates in the world of patients with Crohn’s disease, a lifelong chronic inflammatory bowel disorder that can cause fever, fatigue, abdominal pain, diarrhea, malnutrition and weight loss. There is no cure for Crohn’s disease and its exact causes are unknown.

Individuals with Crohn’s disease are more likely to be hospitalized, with approximately half of them requiring surgery. Crohn’s disease patients are also estimated to be 47% more likely to have a premature death.

In the study, researchers conducted a trial called Randomized Evaluation of an Algorithm for Crohn’s Treatment (REACT, NCT01030809), and the goal was to assess the safety and efficacy of an ECI treatment in comparison to conventional treatment. The trial was conducted at 39 different locations in Canada and Belgium between March 2010 and October 2013, and enrolled 1,982 Crohn’s disease patients. Patients were randomly divided into two types of practices: the ECI, where immunosuppressive medications are given at an early stage in treatment (an antimetabolite and a TNF antagonist), and conventional management for Crohn’s disease, which is characterized by a gradual approach where the patient starts treatment with a milder medication and then moves to stronger medications until his/her symptoms decline.

After 12 months of therapy, researchers found that disease remission rates were similar between the groups, 66% for the ECI practice group and 61.9% for conventional management. After a follow-up of 2 years, researchers found that in terms of major adverse outcomes, however, they were higher in patients under conventional management practices (35.1%) in comparison to patients under ECI practices (27.7%). These major adverse outcomes refer to hospital admission, surgical intervention or serious disease-related complications like pneumonia.

“The results of the REACT trial indicate that patients and practicing clinicians should not be afraid of using early combined treatment,” said in a press release the study’s senior author Dr. Brian Feagan from the Schulich School of Medicine & Dentistry and CEO of Robarts Clinical Trials at Robarts Research Institute. “Treating inflammation, rather than symptoms, is the most effective strategy we have to treat Crohn’s disease.”

“The results of the trial show that early application of highly effective therapy in patients at the greatest risk of complications is a more effective approach to disease management.” added the study’s lead author Dr. Reena Khanna from the Schulich School of Medicine & Dentistry.

The team concluded that although ECI seems to be as effective as conventional management for the control of Crohn’s disease symptoms, the risk of major adverse outcomes associated to it is lower. The authors believe that ECI practices might be able to reduce the mortality rates, adverse outcomes and the high economic burden linked to Crohn’s disease by preventing the serious complications associated to this debilitating condition.