The two-year study involved 129 subjects suffering from Crohn’s disease. 64 participants received the conventional “step up” treatment, while the remaining 65 were managed with “top-down” approach. 36% of the patients who had received the step-up approach were symptom-free after the 26th week of the new study, in comparison to 60% of the “top-down” patients.
The positive results for patients of Crohn’s disease do not end there. Patients with Rheumatoid Arthritis and other chronic auto-immune diseases, such as Ulcerative Colitis, may also benefit from this new form of therapy.
The aftereffects of surgery for Crohn's disease varies, depending upon the location of the inflammation. Patients whose Crohn's is limited to the large intestine (colon and rectum) often do not redevelop the illness (and therefore don't require maintenance medications) if their entire colon and rectum are removed, and they are left with an ileostomy. However, if only part of the colon is removed, then there is a very high likelihood of recurrence of Crohn's disease. At some point, the disease also may recur in patients who have Crohn's of the small intestine, because complete removal of the small intestine is not possible. Patients with Crohn's fistulas often suffer recurrences after surgery, as well.
Selection of treatment regimens depends on disease severity, disease location, and disease-associated complications. Various guidelines recommend that approaches be sequential - initially to induce clinical remission, and then to maintain remissions. Initial evidence of improvement should be seen within 2 to 4 weeks and maximal improvement should be seen in 12 to 16 weeks 3 . The classic approach to therapy in Crohn's disease has been a "step-up" approach starting with the least toxic agents for mild disease, and increasingly more aggressive treatment for more severe disease, or patients who have not responded to less toxic agents. More recently the field has been moving toward a "top-down" approach (early aggressive management) which might decrease exposure to anti-inflammatory agents and increase exposure to agents that enhance mucosal healing that might prevent future complications 4 .