Long-term outcomes of top-down therapy versus a conventional step-up strategy in adults newly diagnosed with Crohn's disease: 5-year follow-up of the PROFILE trial.

Early top-down anti-TNF therapy from Crohn's disease diagnosis reduces surgery and disease progression over 5 years, with a hazard ratio of 5.23 for surgery.

• Why it matters: Long-term management strategies for Crohn's disease are crucial to improve patient outcomes and reduce complications, but evidence on sustained benefits of early aggressive treatment is limited.
• What they did: The PROFILE trial randomized 386 newly diagnosed Crohn's disease patients to either top-down (infliximab plus immunomodulator) or step-up therapy, then followed them for approximately 5 years, analyzing outcomes like surgery, hospital admissions, and disease progression.
• The result: Patients receiving early top-down therapy had fewer surgeries, hospital admissions, and disease complications, demonstrating a potential disease-modifying effect and supporting early aggressive treatment for better long-term outcomes.