APPLICATION OF BIOMARKERS IN CROHN'S DISEASE TREATMENT STRATEGY: NEW APPROACHES AND EFFECTIVENESS ASSESSMENT

Abstract

Goal. The study aimed to evaluate the effectiveness of the "top-down" strategy compared with the accelerated tactics of increasing the dose in achieving stable remission in patients with Crohn's disease. Materials and methods. This randomized, open-label, active-control trial included patients aged 15 to 85 years who were newly diagnosed with Crohn's disease. Participants were divided into two groups to apply either a top-down strategy or accelerated therapy. Inclusion in the study was based on the presence of an active disease, confirmed by the Harvey-Bradshaw index (HBI) ≥7, and elevated markers of inflammation. The study was conducted in accordance with the principles of good clinical practice and used block randomization, taking into account biomarkers and other parameters. Results. In the top-down group, 79% of patients achieved sustained remission without steroids and surgery by week 48, which was significantly higher than 15% in the accelerated enhancement group. More patients in the first group also achieved complete endoscopic remission and improved quality of life. There were no significant differences in biomarkers between the groups, but there was a more rapid improvement in biochemical parameters in the descending group. Conclusions. The top-down strategy is more effective in achieving lasting remission and improving the quality of life in patients with Crohn's disease than accelerated treatment tactics. These results support the application of early and aggressive therapy in clinical practice. The practical significance of the study lies in the possibility of improving long-term prognoses for patients and optimizing healthcare resources. Further studies with large samples and improved biomarker assessment methods are needed to confirm the findings and apply them to personalized treatment approaches.