Harriet HeywoodCambridgeshire
Isobel Wright
Isobel Wright has lived with Crohn’s disease since the 1990s and has faced many challenges
Doctors say a change in how Crohn’s disease is treated could save the NHS millions of pounds and significantly improve patients’ quality of life.
Researchers from Addenbrooke’s Hospital and the University of Cambridge found using biologic drugs like Infliximab soon after diagnosis, rather than when symptoms worsen, was five times more effective at controlling the disease.
New economic analysis of the approach, known as “top-down” treatment, could reduce the cost of care by up to £10,000 per patient over a five-year period.
Isobel Wright, from Suffolk, said her “life could have been very different” if the treatments were available when she was diagnosed as a teenager.
Cambridge University Hospitals NHS Foundation Trust (CUH)
After starting treatment with Infliximab 12 years ago, Ms Wright said she had control over her illness and freedom to travel and pursue horse-riding
Crohn’s disease is characterised by inflammation of the digestive tract and can impact a person’s quality of life with symptoms that include stomach pain, diarrhoea, weight loss and fatigue.
It is typically treated with a “step-up” approach, starting with milder drugs before advanced therapy like Infliximab.
Despite its effectiveness, it was typically reserved for patients with frequent flare-ups due to past concerns about cost and side-effects, including a higher risk of infections from immune suppression.
But, a PROFILE trial, which followed 386 newly diagnosed Crohn’s patients, compared the typical approach with a new treatment of giving Infliximab immediately.
It found patients receiving early effective therapy had higher quality of life scores, made less use of steroid medication, had a lower number of serious infections and a lower number of hospitalisations.
Prof Miles Parkes, who led the trial, said the findings using the new approach marked a turning point in how Crohn’s disease should be managed.
With about 190,000 people in the UK living with the disease and 10,000 diagnosed annually, the early treatment method could save the NHS as much as £20m each year, said Cambridge University Hospitals NHS Foundation Trust (CUH).
It wants national reimbursement guidelines to be updated to encourage more widespread use of the treatment. NHS England has been contacted for comment.
Cambridge University Hospitals NHS Foundation Trust
Prof Parkes said: “The latest work shows that not only is it the best approach for patients, but it will also deliver benefits for healthcare systems too.”
Isobel Wright, 44, from Haverhill in Suffolk, spent years in and out of hospital after being diagnosed with Crohn’s as a teenager.
In 2008, she underwent urgent surgery following a bowel perforation resulting from damage caused by Crohn’s disease, “which was just the start of almost four years of constant, debilitating symptoms”, she said.
It affected her mental health, work and social life, until she was was prescribed Infliximab, which she said was “miraculous”.
She now visits hospital every eight weeks to receive treatment.
Speaking about the PROFILE trial, she added: “If these treatments had been available when I was diagnosed, my life could have been very different.”
Marianne Radcliffe, chief executive of Crohn’s & Colitis UK which supported the study, said having access to safe, effective drugs that saved the NHS money was “a real positive”.
Dr Nuru Noor, first author on the PROFILE trial paper, added that starting an effective treatment from diagnosis was more effective, safer and cheaper than historical approaches.