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On changing treatment protocols

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Posted 12/30/2015 2:43 PM (GMT 0)
Found this on Chronsforum.com. I don't know if it would apply equally to UC, but interesting and a good example of why we need to keep open minds.

"Conventional wisdom about the treatment of Crohn's disease is being turned on its head by a new study.

Traditionally, patients diagnosed with the devastating inflammatory bowel disease are treated with a "step-up" approach, a series of drugs given sequentially as their health deteriorates.

First, they get corticosteroids to control symptoms like abdominal pain and bloody diarrhea. They are then prescribed a powerful immune-suppressing drug, which prepares them for a third medication, an antibody that curbs the inflammation at the root of the disease.

But a group of European and Canadian researchers decided to see what would happen if they treated newly diagnosed Crohn's patients immediately with a combination of an immune-suppressing drug, azathioprine, and an antibody, infliximab, simultaneously. Patients were only treated with steroids if they had symptoms.

In the study, published in today's edition of The Lancet, this "step-down" approach proved to be markedly more effective.

At six months, 60 per cent of patients treated with this method were in remission, compared with 36 per cent in the step-up group.

After a year, 62 per cent of the step-down patients were in remission from Crohn's, compared with 42 per cent of the other group. But the numbers in the latter group rose only because so many had progressed to taking infliximab.

"The conventional approach was far inferior," said Brian Feagan, director of clinical trials at the Robarts Research Institute of the University of Western Ontario in London, Ont., and co-author of the study."[/i

Source: The Globe and Mail (Canada), February 22, 2008 Friday
Posted 12/30/2015 2:53 PM (GMT 0)
but are they actually stepping down the drugs ? what are they stepping down to ?
Posted 12/30/2015 2:54 PM (GMT 0)
Interesting, thanks for the report.
This "hit it hard in the beginning" RX treatment seems to be what more GI's are doing for new patients from reading here on HW. But it would be good to know how many patients are actually "stepped down" to lower level RX meds after reaching remission.

edit to add: ushipped and I posted simultaneously asking the same question. Great minds think alike?
Posted 12/30/2015 3:07 PM (GMT 0)
Why do they call this new protocol the “step down” approach. Is it common that after taking a combination of azathioprine/ infliximab (Remicade) that patients can commonly “step down” from those immune-suppressing drugs to more normal anti-inflammatory drugs like mesalamines?

I thought that almost always once you get hooked on those “big guns” then you are on them forever, or at least until your colon is removed. BTW it is proven that if you are able to get into remission with the 5-ASAs then those drugs will actually decrease your chances of cancer, while those other drugs have much more serious side effects.

To me it makes more sense to first try the mesalamines before those other more drastic protocols.
Posted 12/30/2015 3:09 PM (GMT 0)
I sometimes wish my doctors would stop fannying about with useless - for Crohn's at least - drugs like mesalazine and go straight for the heavy stuff. I might actually be in remission by now if they had. But even if they were willing to do that, I suspect funding issues would prevent them from doing so.

Also, these studies are always so short. I'd like to see where patients are at 5 years later, not 1 year later. Absolutely no reason why it can't be done; I don't know why it isn't.
Posted 12/30/2015 3:16 PM (GMT 0)
$$$$$$$$$$$$ !
Posted 12/30/2015 3:22 PM (GMT 0)

juststud said...
$$$$$$$$$$$$ !

Yep. They've got to show the best remission rates for new (well, new-ish) drugs possible. Drug companies would probably restrict trials to one month if they could get away with it :/

Still, I would have thought there was a university or research institution somewhere in the world that could carry out longer-term drug trials. Can't be that fearfully expensive. Just get patients to fill out a few questionnaires and have a few blood tests once a month, or something - not like you have to put them up in 5 star hotels.
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