Combination therapy with two drugs that control an unruly immune system provided the best relief yet seen for Crohn’s disease, a condition in which the body mistakenly attacks its own intestinal tissue.
The new finding promises to change current treatment of Crohn’s disease, said study leader Dr. William J. Sandborn, vice chair of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn.
The results were reported in the April 15 issue of the New England Journal of Medicine.
Doctors now start treatment of Crohn’s disease with steroids, Sandborn said. If the steroids do not provide relief from the abdominal pain, nausea, fever, weight loss, diarrhea and other symptoms of the condition, the next step is to use azathioprine, which reduces immune system activity broadly. Only if that fails will they try biologics, newer treatments that include monoclonal antibodies such as infliximab (Remicade). These drugs target a specific part of the immune system.
The trial showed that the azathioprine-alone step should be skipped. “This study suggests that the therapy that follows steroids should include a biologic,” Sandborn added.
Therapy with both azathioprine and infliximab appears to be the treatment of choice if steroids are not effective, Sandborn said.