No diff in disease course: early biologics vs step up tx

[xmdmom]

I have not seen the full article but the abstract's conclusions were interesting.


Step Up Versus Early Biologic Therapy for Crohn's Disease in Clinical Practice
Ghazi, Leyla J. MD; Patil, Seema A. MD; Rustgi, Ankur MBBS; Flasar, Mark H. MD, MS; Razeghi, Sanam MD; Cross, Raymond K. MD, MS
Published Ahead-of-Print

Abstract
Background: Recent studies have demonstrated superior outcomes of early biologic therapy. Our purpose was to evaluate differences in disease course among patients in clinical practice treated with early biologic therapy compared with those receiving conventional Step Up therapy.

Methods: Patients with Crohn's disease evaluated from July 2004 to November 2010 at a tertiary referral center were included. Demographic data were obtained from a prospectively maintained database. Patients were categorized into 1 of 2 groups: Early Bio group (with or without concomitant immune suppressants) or Step Up group (initial immune suppressants with or without escalation to biologic). Disease activity, quality of life, use of steroids, and number of hospitalizations, and surgeries were assessed.

Results: Ninety-three patients with Crohn's disease met inclusion criteria: 39 (45%) in the Step Up group and 54 (58%) in the Early Bio group. There was no significant difference in demographic and clinical variables between groups. Mean Harvey-Bradshaw index and Short Inflammatory Bowel Disease Questionnaire scores at 3, 6, and 12 months were not different between groups. Response rates were higher in the Step Up group compared with the Early Bio group only at 3 months. Early Bio patients had a greater number of hospitalizations at 1 year (P = 0.04).

Conclusions: In clinical practice, early biologic therapy did not improve disease activity or quality of life and did not decrease the need for steroids or surgeries 1 year after therapy. Our results suggest that clinical outcomes are not worsened using the conventional approach. Therefore, an accelerated Step Up approach for most patients seems reasonable.

(C) Crohn's & Colitis Foundation of America, Inc.


http://journals.lww.com/ibdjournal/...Early_Biologic_Therapy_for_Crohn_s.99833.aspx

 

[rollinstone]

Thanks for the post, I thought a recent study suggested otherwise :s when was this 1 from? I guess this would be one of the longitudinal studies, not sure if the other one would be able to measure all the same variables just yet because of its recency

 

[xmdmom]

It was published in the "ahead-of-print" so it is current. This is one tertiary med center's experience in clinical practice. Note what they wrote in their background section.

"Background: Recent studies have demonstrated superior outcomes of early biologic therapy. Our purpose was to evaluate differences in disease course among patients in clinical practice treated with early biologic therapy compared with those receiving conventional Step Up therapy."