Top-down treatment of newly diagnosed Crohn’s could be a game changer: study

Top-down treatment should be standard care for newly diagnosed patients, the authors said.

Patients with Crohn’s disease who start on infliximab combined with an immunomodulator have far better outcomes within a year compared with traditional ‘step-up’ treatment, a UK trial shows.

The findings are “potentially transformative” for managing newly diagnosed patients, the study authors report, with early combination therapy more likely to result in long-term steroid-free and surgery-free remission.

“The case appears clear-cut for implementation of top-down treatment as the standard of care for most patients as soon as possible after diagnosis,” they wrote in The Lancet Gastroenterology and Hepatology.

The team, led by the University of Cambridge and the Royal Free Hospital in the UK, were initially investigating whether biomarker-guided treatment would make a difference to patient outcomes.