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Early intervention in Crohn’s disease: towards disease modification trials
Annals of the Rheumatic Diseases ( IF 27.4 ) Pub Date : 2017-09-04 , DOI: 10.1136/gutjnl-2017-314519
Silvio Danese , Gionata Fiorino , Laurent Peyrin-Biroulet

Crohn’s disease (CD) is a chronic progressive destructive inflammatory bowel disease. As in rheumatoid arthritis, there is increasing evidence that early treatment initiation with disease-modifying agents, such as biological drugs, may lead to complete disease control, prevention of disease progression thus protecting against irreversible damage and restoration of normal quality of life. Data from randomised clinical trials with immunosuppressants and biologics suggest that treating patients with a disease duration of <2 years and an absence of complications may significantly reduce the risk for complications and increase time in remission in patients with CD. Moreover, rapid disease control may effectively prevent disease progression and allow dose reduction or even withdrawal of treatment, reducing the risk of long-term adverse events and healthcare costs. However, prospective disease modification trials are needed to confirm these initial results. Here we review the literature regarding early intervention in adult patients with CD and propose criteria for future disease modification trials.



中文翻译:

克罗恩病的早期干预:进行疾病改良试验

克罗恩氏病(CD)是一种慢性进行性破坏性炎症性肠病。与类风湿关节炎一样,越来越多的证据表明,使用疾病改良剂(例如生物药物)进行早期治疗可能会导致疾病的完全控制,疾病的预防,从而防止不可逆转的损害并恢复正常的生活质量。来自免疫抑制剂和生物制剂的随机临床试验数据表明,治疗疾病持续时间小于2年且无并发症的患者,可显着降低CD患者的并发症风险并延长缓解时间。此外,疾病的快速控制可以有效地预防疾病的进展,并可以降低剂量甚至撤消治疗,降低长期不良事件和医疗费用的风险。但是,需要进行前瞻性疾病改良试验来确认这些初步结果。在这里,我们回顾了有关成人CD患者早期干预的文献,并提出了未来疾病改良试验的标准。

更新日期:2017-11-05
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