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Aggressive Therapy for Crohn's Disease Produces Better Outcomes
Date:2/22/2008

ticosteroids. Then, if side effects or steroid resistance develop, it moves on to broad-spectrum immunosuppressive drugs such as Rheumatrex (methotrexate). If all else fails, doctors try tumor necrosis factor (TNF)-blockers, a targeted therapy.

"There is no evidence that that approach is superior to any other approach," Feagan said. "We just eased into that over time, because that's the way the drugs were developed."

For this study, Feagan and his colleagues randomly assigned 133 patients at 18 centers in Belgium, Holland and Germany to receive either combined immunosuppression or the conventional approach.

Financial support for the trial was provided by Centocor BV and Schering-Plough, which make the two immunosuppressive drugs used.

Sixty-seven patients assigned to combined immunosuppression received three infusions of Remicade (infliximab) with Imuran (azathioprine) at the start, two weeks later and four weeks after that.

The remaining 66 patients received steroids followed by Imuran and Remicade.

At six months, 60 percent of 65 patients in the combined immunosuppression group were in remission without steroids or surgery, compared with 35.9 percent of 64 people in the other group.

At one year, 61.5 percent of those in the combined group were in remission versus 42.2 percent in the control group.

"There was clinically meaningful and statistically significant improvement at six months in favor of the combined immunosuppression," Feagan said.

According to an accompanying commentary, the results of another, similar trial are due in late 2008. If those researchers reach the same conclusion, conventional treatment for Crohn's could well change, the commentary noted.

Rajapaksa had one reservation, however.

" Remicade has its own issues. For instance, it's given intravenously so the individual has to go to the doctor's office," she said.

"And becau
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