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Recent advances in clinical practice
Early intervention in Crohn’s disease: towards disease modification trials
  1. Silvio Danese1,2,
  2. Gionata Fiorino1,
  3. Laurent Peyrin-Biroulet3
  1. 1Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Milan, Italy
  2. 2Department of Biomedical Sciences, Humanitas University, Milan, Italy
  3. 3Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
  1. Correspondence to Dr Silvio Danese, Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano, Milan, Italy; sdanese{at}hotmail.com

Abstract

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.

  • Crohn’s disease
  • pharmacotherapy
  • immunoregulation

https://doi.org/10.1136/gutjnl-2017-314519

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    Footnotes

    • Contributors All the authors drafted the manuscript and critically revised and accepted the final version.

    • Competing interests SD has served as a speaker, consultant and advisory board member for Schering-Plough, Abbott Laboratories, Merck, UCB-pharma, Ferring, Cellerix, Millenium Takeda, Nycomed, Pharmacosmos, Actelion, Danone, Alpha Wasserman, Genentech, Grunenthal, Pfizer, Astra Zeneca, Novo Nordisk, Cosmo Pharmaceuticals, Vifor and Johnson & Johnson; GF served as a consultant and advisory board member for MSD, AbbVie, Takeda, Janssen, Mundipharma, Celltrion, Alfa Wassermann, Sandoz and Pfizer; LP-B: Honoraria from Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, HAC-Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH, Celgene, Biogen, Lycera and Samsung Bioepis.

    • Provenance and peer review Not commissioned; internally peer reviewed.