(February 21, 2008 - Insidermedicine) Combining immunosuppressive drugs early in Crohn’s disease is a more effective therapy than the conventional method of using these agents in sequence, according to a clinical trials published in The Lancet.

Here are some guidelines for monitoring complications when treating Crohn’s disease with corticosteroids from the American Gastroenterological Association Institute:

•    Conduct periodic bone mineral density assessments in patients on corticosteroid therapy for over three months.

•    Conduct annual ophthalmologic examinations for patients on long-term corticosteroid therapy.

•    Monitor patients using corticosteroids for glucose intolerance and other metabolic abnormalities.

Researchers from Imelda General Hospital randomized 133 patients with Crohn’s from medical centers in Belgium, Holland, and Germany to one of two treatment arms as part of a two-year open-label trial. The first group received treatment with three infusions of infliximab (5 mg/kg of bodyweight) at weeks 0, 2, and 6, in combination with azathioprine. These patients also received additional infliximab and corticosteroids as needed, to control disease activity. The second group received treatment with a conventional protocol of corticosteroids followed by azathioprine and infliximab, given in sequence.

At week 26, 60% of patients in the combined treatment group were in remission without the need for corticosteroids or surgical resection, compared with only 36% in the conventional treatment group. This difference was maintained out to 52 weeks, at which point 61% of the combined therapy group and 42% of the conventional therapy group were in remission. Rates of serious adverse events were similar in both groups.

Today’s research highlights the fact that the standard approach to treating Crohn’s disease may need to change. If additional research supports the findings of this trial, recommendations may suggest starting newly diagnosed patients on combined immunosuppressive therapy, since it appears to be more effective and just as safe as the standard sequential approach.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.