March 24, 2020
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Early biologics linked with better Crohn’s outcomes

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Early biologic treatment is associated with improved outcomes in patients with Crohn’s disease, according to study results.

Ryan C. Ungaro, MD, of the Icahn School of Medicine at Mount Sinai, and colleagues wrote that biologics are often used later in treatment, after other therapies such as corticosteroids or thiopurines.

“There is an increasing volume of evidence suggesting that early use of biologics can improve rates of remission and disease complications,” they wrote. “Despite these data, the rates of early adoption of biologic therapy are quite low in real-world practice.”

Researchers searched the literature for studies and conference abstracts that included patients who initiated biologics within 2 years of a CD diagnosis, or earlier if a biologic-first, top-down strategy was compared with conventional step-up therapy. They performed a meta-analysis to compared clinical remission, relapse and endoscopic healing rates between early biologic treatment and late/conventional treatment.

Investigators found 47 studies comprising 18,471 patients that fit their criteria.

In their analysis, Ungaro and colleagues determined that early use of biologics are associated with higher rates of clinical remission (OR = 2.1; 95% CI, 1.69-2.6), lower relapse rates (OR = 0.31; 95% CI, 0.14-0.68) and higher mucosal healing scores (OR = 2.37; 95% CI, 1.78-3.16) when compared with conventional therapy.

“There are still limited data on longer-term outcomes such as prevention of complications, bowel damage, disability and durability on drug,” they wrote. “Further studies should continue to understand if early intervention with a more treat to target/tight control approach impacts long-term outcomes, and if the improved response rates with shorter disease duration applies to all classes of biologics/targeted agents.” – by Alex Young

Disclosure: Ungaro reports serving on the advisory board or consulting for Eli Lilly, Janssen, Pfizer and Takeda. He also reports receiving research grants from AbbVie, Boehringer Ingelheim and Pfizer. Please see the full study for all other authors’ relevant financial disclosures.