Good News (if other studies confirm) for People with Crohn's Disease !

A one-year study of ~400 people newly diagnosed with Crohn’s bowel disease found that the immediate administration of an antibody (infliximab) targeting proteins which contribute to gut inflammation significantly improved outcomes.

In the past, because of its cost and feared side-effects, infliximab has only been used after the usual treatments of dietary changes, older immunosuppressants (such as steroids) have failed.

The disease can be life-threatening, not simply profoundly debilitating. Extensive and repeated abdominal surgeries are often required.

In this study 80% of those receiving infliximab at the time of initial diagnosis had symptom control compared to 15% in the standard treatment group. Just 0.5% in the immediate treatment group required surgery compared to 4.5% in the standard group.

These findings suggest early use of infliximab greatly improves patient lives and reduces the need for costly procedures later on.

Here is a link to the original non-paywalled article in Lancet
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00034-7/fulltext

And one to a more readable summary in New Scientist
https://www.newscientist.com/article/2418516-early-drug-treatment-leads-to-better-outcomes-for-crohns-disease/

I have some preliminary thoughts about the study, which, if confirmed, will truly change the therapeutic paradigm for Crohn’s (and possibly other diseases).

First is that it was an open label study—everyone knew who was getting which treatment. Second, it (I believe) is an industry sponsored trail—this is not prima facia evidence of a biased study; however, historically, industry sponsored studies more often show positive results than do those with other funding sources. Given the cost of the study drug, it is unlikely that such a preliminary study would have had any chance of finding any other source of funding. Lastly, given that Crohn's is a lifelong condition, a one-year study is pretty short.

Most fascinating to me (and which gives me confidence in the study—as well as in science in general) is that the study was actually designed to look at something else! Sadly, being a serendipitous finding also somewhat undermines the marvelous results as the study was not designed to look at this particular hypothesis.

There is a growing awareness in medical science that our traditional ways of looking at disease by organ systems may be outdated. This has first become evident in cancer—where more focus is being changed to the underlying pathobiology of a cancer as opposed to what organ it initially manifests in.

In the case of the current study, the hypothesis being tested was that the targeting of particular blood biomarkers in people with Crohn’s could be used to guide therapy. This turned out to not be true! Instead, the finding that early infliximab was extraordinarily effective turned up.

Yet, it is worth recalling that many scientific discoveries have been made when looking for something else entirely—something which, being unknown, cannot be put into a grant proposal!

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