Earlier combined treatment can alter the course of disease progression in Crohn’s disease
Canada has one of the world’s highest rates of people living with Crohn’s disease, a chronic inflammatory bowel disease. New cases of the disease are also among the highest in the world, doubling since 1995. People with Crohn’s disease are more likely to require hospitalization, with half requiring surgery, and are 47 per cent more likely to die prematurely.
Dr. Brian Feagan has completed the first randomized cluster trial studying Crohn’s disease treatment, demonstrating that early combined immunosuppression (ECI) treatment in community practices can alter the natural progression of the debilitating disease.
Dr. Feagan is a professor in the Departments of Medicine, and Epidemiology and Biostatistics at Schulich School of Medicine & Dentistry, and CEO of Robarts Clinical Trials at Robarts Research Institute.
The Lancet has published the results of the Randomised Evaluation of an Algorithm for Crohn’s Treatment (REACT) trial, which compares the efficacy and safety of the ECI treatment to conventional management of Crohn’s disease.
The trial was conducted in 39 sites with 1,982 patients throughout Canada and Belgium between March 15, 2010, and October 1, 2013. Patients were recruited into two types of practices.
One set of practices implemented the REACT ECI algorithm, which combines two medications introduced at an early stage in treatment.
The second set of practices used conventional management for Crohn’s disease – a gradual approach which starts the patient on a milder medication and moves them to stronger medications until the patients’ symptoms are alleviated or reduced.
Two years into the study, fewer patients in the ECI practices had major adverse outcomes compared with patients at conventional management practices – 27.7 per cent and 35.1 per cent of patients respectively. Major adverse outcomes are defined as surgical intervention, hospital admission or serious-disease complications, such as pneumonia.
Dr. Feagan credits the reduction in adverse outcomes to the earlier introduction of therapy at ECI practices. “The results of the REACT trial indicate that patients and practising clinicians should not be afraid of using early combined treatment,” said Dr. Feagan. “Treating inflammation, rather than symptoms, is the most effective strategy we have to treat Crohn’s disease.”
According to Dr. Khanna, lead author of the study, “The results of the trial show that early application of highly effective therapy in patients at the greatest risk of complications is a more effective approach to disease management.” Dr. Khanna is an associate professor, Schulich Medicine & Dentistry and clinical research scientist, Robarts Clinical Trials.
By preventing the severe complications associated with Crohn’s disease, even in patients with long-standing disease, ECI may reduce the high economic burden, mortality rates and adverse outcomes associated with Crohn’s disease.
Support for the study was provided by AbbVie.