Combination Therapy Treats Crohn's Disease
Study Shows Combination of Biologic and Immune-Suppressing Drugs Is Best Treatment for Crohn's
April 14, 2010 -- Patients with moderate to severe Crohn's disease are most likely to get better if treated with a combination of biologic and immune-suppressing therapies, a clinical trial suggests.
It's a "landmark trial," says gastroenterologist David Kerman, MD, assistant professor of clinical medicine at the University of Miami Miller School of Medicine, who was not involved in the study.
"This is very important news," Kerman tells WebMD. "It says that combination therapy is actually better in these patients at an earlier point in the disease than previously thought."
The findings already have changed clinical practice, says study researcher William Sandborn, MD, vice chair of gastroenterology at the Mayo Clinic in Rochester, Minn.
The trial enrolled 508 patients. It tested a combination of Remicade and azathioprine, an immunosuppressive drug, against each drug by itself. Remicade is one of three approved "biologic" Crohn's treatments that block TNF, a major player in the immune responses that inflame the intestines of Crohn's patients.
After 26 weeks of treatment, patients getting the combination had a 57% chance of disease remission, compared to 44% of those getting Remicade alone and to 30% of those getting azathioprine alone. Similar results were seen after 50 weeks of treatment.
The combination treatment worked even better in patients with colonoscopy-confirmed disease and blood-test evidence of inflammation. Among these patients, 69% achieved remission with the combination treatment compared to 57% of those on Remicade alone and to 28% of those on azathioprine alone.
"For patients who don't initially respond to corticosteroids, or who don't continue to respond when we taper down corticosteroids, those patients are best treated with a combination of anti-TNF and immune-suppressive drugs, Sandborn tells WebMD. "That will give patients their best chance of being off steroids and having a healthy bowel."
Some specialists are skipping steroids and going straight to the combination, Kerman says.
"Some patients require corticosteroids, but I think that more and more we are realizing that corticosteroids may change the natural history of Crohn's disease for a worse outcome," he says. "Using biological therapies and immune modulators may preclude the need for ever needing corticosteroids."