Proactive treatment is always preferred over reactive treatment. This was the motto of researchers at Robarts Clinical Trials at Western University, who wanted to find a more reliable, proactive treatment option for Crohn’s Disease and related complications. Led by Dr. Brian Feagan, the clinical trial entitled REACT (Randomized Evaluation of an Algorithm for Crohn’s Treatment) involved nearly 2,000 patients, claiming to provide an accelerated step-care therapy with a combination of immunosuppressive drugs in comparison to the traditional sequential therapy.

Crohn’s disease is one of a collective set of conditions which form the Inflammatory Bowel disease (IBD) indication. It causes inflammation of the small bowel (illeum) and beginning of the colon, and can also affect any part of the gastrointestinal tract, in combination with ulcerative colitis, which is a close form of the same disease. IBD can cause diarrhea, rectal bleeding, bowel obstruction, chronic abdominal pain, and loss of appetite among other symptoms. It is believed to affect more than 5 million people globally.

This particular study involved 39 community gastrointestinal practice clinics throughout Canada and Belgium, where the doctors were advised to prescribe to patients accelerated step-care combination therapy instead of the traditional ones, and collect their feedback on the convenience or inconvenience faced in managing Crohn’s disease-related complications over a span of 24 months. Up to 60 patients per practice were given the combination of drugs.

According to Dr. Brian Feagan, CEO and senior scientific director of Robarts Clinical Trials and a professor in the Division of Gastroenterology at Western’s Schulich School of Medicine & Dentistry, “There is a certain amount of resistance by physicians and also patients who say they are already using one immunosuppressant drug and now you want to give me another? That seems more complicated, is considered by some to be more toxic, but there is no indication that is the case.” He had indicated that high-risk patients would benefit from this therapy.

As indicated, the results of the trial also pointed to a similar situation. Patients with remissions at 12 months were only marginally ahead in management of complications, but those at high risk reported considerable reductions in the rates of hospitalizations, surgeries, and complications when given a combination of immunosuppressants.

Though physicians are more comfortable in prescribing a sequential intensification therapy, Dr. Feagan was confident that the results of the clinical trial were bound to bring about a change in their thought process. As he was quoted saying, “If you take the sickest patients, and you use that approach, you will have a much more dramatic treatment approach.That is something that will open the eyes of a lot of docs around the approach to therapy and Crohn’s disease.”