Anti-tumor necrosis factor therapy is an important treatment option for management of active Crohn's disease and is labeled for use after failure of conventional therapy. 

However, there is debate on the introduction of anti-TNF agents earlier in the treatment strategy to potentially improve clinical outcomes. 

 

Dr David Rubin from the USA determined if a top-down approach with anti-TNF therapy is associated with improved outcomes for patients with active Crohn's disease.

Claims data were from adult patients with Crohn's disease with continuous enrollment in the same health plan for ≥6 months prior to the initial diagnostic claim for Crohn's disease, 12 months after their initial anti-TNF claim, and with anti-TNF claims after their initial diagnosis for Crohn's disease.

 

The research team identified 3 patient groups.

A top-down approach to anti-TNF therapy was associated with a lower risk of corticosteroid use

Inflammatory Bowel Diseases

 

The Step-Up group used 5-aminosalicylates and/or corticosteroids prior to anti-TNF.

 

Secondly, the immunosuppression (IS)-to-TNF inhibitor group used IS prior to anti-TNF therapy.

 

Finally, the Early-TNF group initiated anti-TNF therapy within 30 days of the first prescription for Crohn's disease.

 

Response to anti-TNF therapy was determined up to 24 months following anti-TNF initiation by concomitant corticosteroid use, Crohn's disease surgery, anti-TNF dose escalation, and anti-TNF discontinuation/switch. 

The doctors reported that a top-down approach to anti-TNF therapy was associated with a lower risk of concomitant corticosteroid use, anti-TNF dose escalation, discontinuation/switch of anti-TNF, and Crohn's disease-related surgery compared with the step-up and IS-to-TNF therapy approaches.

Dr Rubin's team concludes,  "These 'real-world' data show that a top-down approach to anti-TNF therapy in Crohn's disease is associated with reductions in loss of response and fewer surgeries than conventional step-wise management."