Early access to Crohn's drug reduces need for surgery reveal Cambridge University researchers

Former TOWIE star Sam Faiers suffers from the disease. Credit: PA images

Starting people with Crohn's disease on an advanced therapy soon after diagnosis could dramatically reduce the need for surgery, according to a new study.

Crohn's disease is a life-long condition characterised by inflammation of the digestive tract and as many as one in 10 patients will require urgent abdominal surgery to treat their condition within their first year of diagnosis.

But a new study - called the Profile trial - by the University of Cambridge says that figure can be reduced significantly by early access (within the first two years of diagnosis) to a drug called infliximab.

The drug is usually only offered to patients who have regular flare-ups and do not respond to other medication.

Infliximab targets a natural protein in the body called tumour necrosis factor-alpha (TNF-alpha). It plays an important role in helping the immune system fight infections.

Too much TNF-alpha can damage the cells lining the gut. This is thought to partly cause the gut inflammation of people with Crohn’s or Colitis. Infliximab helps blocking the harmful effects and reduces inflammation.

It is usually administered through an intravenous drip or injections.

Those with Crohn's and Colitis could experience diarrhoea, feel tired and dehydrated.

Researchers found that prescribing it to patients soon after diagnosis could "prevent the majority of adverse outcomes" from Crohn's disease.

Prof Miles Parkes, director of the NIHR Cambridge Biomedical Research Centre and chief investigator of the Profile trial, said: "Up until now, the view has been 'why would you use a more expensive treatment strategy and potentially over-treat people if there's a chance they might do fine anyway?'

"As we've shown, and as previous studies have demonstrated, there's actually a pretty high risk that an individual with Crohn's disease will experience disease flares and complications even in the first year after diagnosis.

"We now know we can prevent the majority of adverse outcomes, including need for urgent surgery, by providing a treatment strategy that is safe and becoming increasingly affordable."

Crohn's disease

What is Crohn's disease?

According to the NHS Crohn's disease is a "lifelong condition where parts of the digestive system become inflamed."

Crohn's and Colitis UK describe it as a type of Inflammatory Bowel Disease, where "parts of the gut become swollen, inflamed, and ulcerated.

"This can cause pain, diarrhoea, weight loss and tiredness – and you may have other symptoms too."

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What are the common symptoms?

The main symptoms are:

  • diarrhoea

  • stomach aches and cramps

  • blood in your poo

  • tiredness (fatigue)

  • weight loss

  • The symptoms may be constant or may come and go every few weeks or months. When they come back, it's called a flare-up.

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Is there a cure?

Unfortunately there's no cure for Crohn's disease, but there are a number of drug treatments - such as the one mentioned in this article.

The medicines will often be used to reduce inflammation in the digestive system or stop the inflammation returning.

Other interventions might include surgery - where parts of the digestive system is removed.

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Is there anyone I might know with the condition?

A number of famous people have been diagnosed with the disease.

Dr Who star Sascha Darwan, musicians Tom Speight and Anastacia and TOWIE star Sam Faiers have all become ambassadors for the Crohn's charity.

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Researchers split the 386 patients on the Profile trial into two groups. Half were given conventional treatment while the other half were offered a "top-down" approach and were given infliximab as soon as possible after their diagnosis regardless of symptoms.

The majority (80%) of those on infliximab had their symptoms controlled for one year compared to just 15% in the conventional group.Prof Parkes added: "If you take a holistic view of safety, including the need for hospitalisations and urgent surgery, then the safest thing from a patient point of view is to offer 'top-down' therapy straight after diagnosis rather than having to wait and use 'step-up' treatment."

Magician Steven Frayne, formerly known as Dynamo also has the condition Credit: PA

First author Dr Nuru Noor, of the Department of Medicine at the University of Cambridge, said the findings - published in The Lancet Gastroenterology andHepatology "redefine what should be considered early treatment".

He added: "Historically, treatment with an advanced therapy like infliximab within two years of diagnosis has been considered 'early' and an 'accelerated step-up' approach therefore 'good enough'.

"As soon as a patient is diagnosed with Crohn's disease, the clock is ticking - and has likely been ticking for some time - in terms of damage happening to the bowel, so there's a need to start on an advanced therapy such as infliximab as soon as possible.

"We've shown that by treating earlier, we can achieve better outcomes for patients than have previously been reported."

Ruth Wakeman, director of services, advocacy and evidence at Crohn's & Colitis UK, said: "This study shows what a dramatic difference early treatment with advanced therapy can make to newly diagnosed patients.

"People with Crohn's don't want to be stuck in hospital or having surgery, they want to be out in the world, living their lives. Anything that speeds up the path to remission can only be a good thing."

The study was funded by Wellcome and PredictImmune Ltd, and supported by the NIHR Cambridge Biomedical Research Centre.

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