Early Combined Immunosuppression in Crohn Disease: A Community-Based Trial

In treatment-naive patients with Crohn disease, early treatment with a combination of a tumor necrosis factor (TNF) blocker and an antimetabolite (azathioprine, 6-mercaptopurine, or methotrexate), or early combined immunosuppression (ECI), is recognized to result in the highest remission rates. In an industry-funded, cluster-randomized study of community practices, investigators tested the efficacy of ECI versus conventional step-up management. The primary outcome was the rate of steroid-free remission at month 12. Patients were followed for 24 months.

In ECI-randomized practices, after initial mandated steroid trials (4 weeks in Canada and 12 weeks in Belgium), ECI was started if the Harvey-Bradshaw Index score was >4. The baseline level of…