Steroids as a last resort?
A trial reported in The Lancet (full article by subscription) found that people treated by more aggressive medications earlier achieved better outcomes than those treated in the traditional manner.
Combined immunosuppression was more effective than conventional management for induction of remission and reduction of corticosteroid use in patients who had been recently diagnosed with Crohn's disease. Initiation of more intensive treatment early in the course of the disease could result in better outcomes.
As explained by The Globe and Mail:
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.
This study shows that reversing the conventional order, using infliximab as the initial treatment, could provide better long-term results. Coincidentally, the more aggressive medications are typically much more expensive, though the improved results could outweigh this with lower overall medical costs.
I don't see this report as leading to any treatment changes in the near future. The inertia of conventional treatment requires larger, longer-term trials to be overturned. However, after the positive results of this report, I'm sure just such trials are being planned.
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