{"id":605582,"date":"2026-09-19T19:44:22","date_gmt":"2026-09-19T19:44:22","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/605582\/"},"modified":"2026-09-19T19:44:22","modified_gmt":"2026-09-19T19:44:22","slug":"top-down-therapy-in-crohns-disease-improved-outcomes","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/605582\/","title":{"rendered":"Top-Down Therapy in Crohn\u2019s Disease Improved Outcomes"},"content":{"rendered":"

EARLY top-down anti-TNF treatment from Crohn\u2019s disease<\/a> diagnosis was associated with improved 5-year outcomes compared with step-up therapy, according to follow-up results from participants in PROFILE, a multicentre, open-label, randomised controlled trial. These findings highlighted how early top-down intervention might have a disease-modifying effect in Crohn\u2019s disease.\u00a0<\/p>\n

PROFILE Investigated Top-Down Therapy in Crohn\u2019s Disease\u00a0<\/p>\n

PROFILE included 386 patients aged 16\u201380 years with newly diagnosed Crohn\u2019s disease and was completed in 40 hospitals in the UK. Patients were randomly assigned either a top-down treatment strategy involving infliximab and an immunomodulator or a step-up strategy.\u00a0<\/p>\n

Previous results from the PROFILE trial revealed better 48-week outcomes for patients with Crohn\u2019s disease who received top-down anti-TNF treatment from diagnosis compared with patients who received conventional step-up therapy.\u00a0<\/p>\n

PROFILE 5-Year Follow-Up\u00a0<\/p>\n

In this study, researchers followed up with participants of the PROFILE trial using outcome data extracted for up to 5 years after the week 48 visit to assess whether the benefits of a top-down treatment strategy resulted in long-term disease course modification. The primary outcome was the need for Crohn\u2019s disease-related abdominal surgery.\u00a0\u00a0<\/p>\n

In total, 358 patients had post-week 48 records and median follow-up was approximately 5 years. Notably, 89% of patients receiving step-up treatment and 99% of patients receiving top-down treatment had received biological or immunomodulator therapy.\u00a0<\/p>\n

Outcomes\u00a0<\/p>\n

Twenty-eight Crohn\u2019s disease-related abdominal surgeries were recorded in 26 patients who received conventional step-up treatment, compared with six surgeries in six patients who received early top-down therapy.\u00a0<\/p>\n

Patients in the step-up group had a shorter time to surgery than patients in the top-down group (adjusted hazard ratio [aHR] 5.23; 95% CI 1.99\u201313.76; p=0.0008).\u00a0<\/p>\n

Patients who received conventional step-up treatment were also more likely to experience a Crohn\u2019s disease-related hospital admission than those who received early top-down treatment (21% vs 11%). Time to first hospital admission was significantly shorter in the step-up group (aHR 2.01; 95% CI 1.18\u20133.41; p=0.017).\u00a0<\/p>\n

Progression to stricturing or penetrating Crohn\u2019s disease was also less frequent in patients who received early top-down treatment (7% vs 17%), and time to disease progression was longer in this group (aHR 2.46; 95% CI 1.25\u20134.86; p=0.010).\u00a0<\/p>\n

Conclusion\u00a0<\/p>\n

Overall, researchers concluded that early top-down anti-TNF treatment from diagnosis was associated with improved long-term outcomes at 5 years compared with step-up treatment. The authors continued to explain that the robustness of these findings was supported by the completeness of long-term data and benefits across all major disease modification outcomes.\u00a0<\/p>\n

These results suggest that early top-down treatment may have a disease-modifying effect in Crohn\u2019s disease.\u00a0<\/p>\n

Reference\u00a0<\/p>\n

Noor NM et al. Long-term outcomes of top-down therapy versus a conventional step-up strategy in adults newly diagnosed with Crohn\u2019s disease: 5-year follow-up of the PROFILE trial. Lancet Gastroenterol Hepatol. 2026; DOI: 10.1016\/S2468-1253(26)00192-5.\u00a0<\/p>\n

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