Children newly diagnosed with Crohn's disease may benefit from early treatment with the biologic drugs known as anti-TNF-α agents, according to a new study in Gastroenterology1, the official journal of the American Gastroenterological Association.
"While the use of biologic drugs, such as infliximab or adalimumab, is generally reserved for patients who have failed previous therapy for Crohn's disease, little is known about outcomes following the earlier use," said study author Jeffrey S. Hyams, MD, from Connecticut Children's Medical Center, Hartford. "This new research finds that, in children newly diagnosed with moderate to severe Crohn's disease, early anti-TNF-α therapy is more effective at achieving remission than the current standard treatment."
Using data from the RISK Stratification Study, an ongoing, prospective observational research program currently involving 28 pediatric gastroenterology centers in North America, researchers compared the effectiveness of early (within three months after diagnosis) treatment with anti-TNF-α inhibitors, compared with early treatment with immunomodulatory drugs, in attaining clinical remission and facilitating growth in children with Crohn's disease. The current standard of care is corticosteroids followed by the early introduction of immunomodulatory drugs.
At one-year, 85 percent of patients receiving early anti-TNF-α therapy alone were in corticosteroid-free clinical remission, a significantly greater proportion than those treated with either early immunomodulators alone (60 percent) or no early immunotherapy (54 percent). Further, at one-year, no patients in the early anti–TNF-α group had a Pediatric Crohn's Disease Activity Index of greater than 30, compared with 7 percent in the early immunomodulators group and 10 percent in the no early immunotherapy group. Only in the early anti-TNF- α group was normal growth velocity established.
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1. Walters TD et al. Increased Effectiveness of Early Therapy With Anti–Tumor Necrosis Factor-α vs an Immunomodulator in Children With Crohn's Disease. Gastroenterology 2014; 146(2): 383-391.