Fan YH, Wang MW, Gao YN, Li WM, Jiao Y. Genetic and environmental factors influencing Crohn’s disease. World J Gastrointest Surg 2025; 17(3): 98526 [PMID: 40162410 DOI: 10.4240/wjgs.v17.i3.98526]
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05755618
Submitted on:
February 25, 2025, 07:09
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Reader Comments:
Top-down therapy for Crohn's disease (CD) involves starting with the most potent medications, such as biologics and immunomodulators, immediately after early diagnosis. This strategy may lead to rapid induction of remission, promotion of mucosal healing, prevention of complications, and reduced need for surgery. However, the background factors influencing this top-down therapy have not been sufficiently examined.
A recent report on a Japanese cohort found that factors significantly associated with the recent top-down treatment approach were male gender, perianal lesions, no immunomodulators, and anti-tumor necrosis factor therapy. (Miyoshi J, Yoon A, Matsuura M, Hisamatsu T. Real-world use of biologics during the first year of treatment for newly diagnosed Crohn's disease in Japan: a claims analysis from 2010 to 2021. Intest Res. 2025 [PMID: 39848334 DOI: 10.5217/ir.2024.00082])
Top-down therapy for CD should be considered case-by-case, weighing potential benefits against risks and costs. As the authors suggest, identifying patients with a high genetic predisposition for CD may help predict their response to medications, the risk of side effects, and the cost-effectiveness. Further investigation in this area is desirable.
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