Key Points
- The PROFILE clinical trial found that early and aggressive immunosuppressive therapy using tumor necrosis factor (TNF) inhibitors is significantly more effective than conventional therapy for patients with newly diagnosed Crohn’s disease.
- In the trial involving 386 patients, those who received “top-down” therapy (combination of anti-TNF and an immunomodulator) showed a higher rate of sustained steroid- and surgery-free remission at 48 weeks compared to those on an accelerated “step-up” approach with conventional treatment and steroids (79% vs 15%).
- Patients in the top-down group experienced fewer adverse events, serious adverse events, and complications requiring surgery. There was no significant difference in serious infections between the two groups.
- The rate of endoscopic remission, which correlates with better long-term outcomes and reduced need for surgery, was significantly higher in the top-down group compared to the step-up group (67% vs 44%).
- The study advocates for the use of biologic agents and combination therapies in Crohn’s disease to achieve better long-term outcomes, including reduced rates of complications and improved quality of life.