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New Treatment Strategy For Crohn's Disease Shows Promise
When treating patients with Crohn's disease, early use of an intensive
combined immunosuppression (CI) in combination with
conventional management is more effective than the current standard,
treatment with corticosteroids. These outcomes were reported in an
Article in the February 23, 2008 issue of The Lancet.
Crohn's disease is a gastrointestinal disorder which is indicated by
chronic inflammation of the wall of the digestive tract, usually in the
ileum or large intestines. Current medical guidelines recommend that
the active disease should be treated with corticosteroids, which are
similar to steroid hormones in the body. These drugs usually treat the
symptoms of Crohn's well, but many patients become resistant to or
dependent on them. Prolonged exposure can induce Cushing's Syndrome and
therefore an increased risk of mortality.
This alternative treatment, combined immunosuppression, was
investigated by Dr Geert D'Haens, Imelda Gastrointestinal Clinical
Research Centre, Imelda General Hospital, Bonheiden, Belgium, and
colleagues. In a two year, open label, randomized trial, 133 patients
at 18 centers in Europe were divided evenly to receive one of two
treatments: one with infliximab with azathioprine initially and after 2
and 6 weeks, with additional infliximab and corticosteriods if
necessary; and a second with a conventional treatment, intially with
corticosteroids and followed by azathioprine and inflicimab. Primary
outcome measures of the study at weeks 26 and 52 were remission without
corticosteroids and without bowel resection.
At week 26, 60.0 percent of patients who underwent initial CI were in
remission without the use of corticosteroids and without surgical
resection. In contrast, 35.9 percent in the conventional management
group had this outcome. By week 52, the rates were 61.5 percent and
42.2 percent respectively. Serious adverse events were similar in both
groups (30.8 percent for CI, and 25.3 percent in conventional therapy.
The authors conclude, emphasizing the positive potential of this study:
"Combined immunosuppression was more effective than conventional
management for induction of remission and reduction of corticosteroid
use in patients who had recently been diagnosed with Crohn's disease.
Initiation of more intensive treatment early in the course of the
disease could result in better outcomes."
Dr William Sandborn, Inflammatory Bowel Disease Clinic, Mayo Clinic,
Rochester, MN, USA, contributed a Comment in the same issue of The
Lancet, in which he said that the results of another deep
study in this area, known as the SONIC trial, are due soon and much
anticipated. He states: "If the
preliminary data on initial combination therapy in early Crohn's
disease reported by D'Haens
and colleagues are confirmed, the treatment algorithm for patients with
Crohn's disease will
change."
Early
combined immunosuppression or conventional management in patients with
newly diagnosed Crohn's disease: an open randomised trial
Geert
D'Haens, Filip Baert, Gert van Assche, Philip Caenepeel, Philippe
Vergauwe, Hans Tuynman, Martine De Vos, Sander van Deventer, Larry
Stitt, Allan Donner, Severine Vermeire, Frank J Van De Mierop,
Jean-Charles R Coche, Janneke van der Woude, Thomas Ochsenkühn, Ad A
van Bodegraven, Philippe P Van Hootegem, Guy L Lambrecht, Fazia Mana,
Paul Rutgeerts, Brian G Feagan, Daniel Hommes.
The Lancet - Vol. 371, Issue 9613, 23 February 2008,
Pages 660-667
Click
Here For Summary
Written by Anna Sophia McKenney
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Noua strategie de tratament pentru boala Crohn aratã promit - New Treatment Strategy For Crohn's Disease Shows Promise - articole medicale engleza - startsanatate