Steroids? 5-ASAs? How About Trying Biological Therapy First? Sounds Good to Me.

Well, this would have been nice to know about 10 years ago!

For those of you how are in a hurry, here's the main gist of the article:



"There is no known cure for Crohn's disease, and traditional treatment is focused on a "step-up" strategy of managing inflammatory symptoms, starting with simpler and less costly oral medications such as aminosalicylates (5-ASAs) and corticosteroids, and escalating through a series of steps to more expensive biological therapies that target specific proteins in the immune system's inflammatory response. 


David Rubin, MD, associate professor of medicine and co-director of the University of Chicago Medicine's Inflammatory Bowel Disease Center, studied a newer "top-down" strategy that reverses this order of treatment. He found that patients treated with biologic therapies earlier were significantly less likely to need steroids, lose response to their biologic therapy, and require surgery related to their Crohn's disease. "We're essentially reversing the management strategy in Crohn's disease," Rubin said. "


The article doesn't actually say why this is.  My gut reaction (yes, pun intended!) is that the biologicals reduce the potential for flareups early on, meaning that there is less inflammation, less scarring, less infections, and less problems caused by the other medicines.  All of these things make Crohn's worse, so reducing these would keep the flareups in the future from being as bad as they would be without reducing these other problems.


Link - http://www.medicalnewstoday.com/releases/244260.php