Marla Dubinsky, MD, Reframes the First Steps in Crohn’s Disease
At the 2025 Advances in Inflammatory Bowel Disease annual meeting, Marla Dubinsky, MD, emphasized that the moment of diagnosis represents a critical opportunity to alter disease trajectory through early, effective intervention. “A new diagnosis is the golden moment,” she stated, “and time is of the essence” for patients newly diagnosed with Crohn’s disease (CD).
Dr Dubinsky is a professor of Pediatrics and Medicine (Gastroenterology) at the Icahn School of Medicine and chief of the Division of Pediatric Gastroenterology at Mount Sinai Kravis Children's Hospital in New York, New York.
The session focused on 3 core objectives: understanding the key drivers of therapeutic decision-making, applying early intensive strategies to mitigate risk, and integrating current guidelines to position treatments more effectively. Dr Dubinsky underscored that step-up therapy is not appropriate for CD, and that delaying effective treatment can result in irreversible damage.
She explained that patients often have had subclinical CD for years before receiving a diagnosis, meaning inflammation and structural changes may already be present at the time of evaluation. According to Dr Dubinsky, early risk stratification is essential to identify patients who would benefit most from intensive treatment. “Anything more than mildly active disease and/or medium to high risk of progression should prompt early therapy,” she advised.
Clinicians were urged to move beyond symptom control and adopt treat-to-target strategies aimed at mucosal healing. Regular disease monitoring, including biomarker and imaging assessments, should guide therapy adjustments. “Don't settle for symptom improvement alone,” Dr Dubinsky said. “Treat to a target, and individualize that target.”
Disease location plays a central role in treatment selection. About 70% of CD patients have ileal involvement, which is particularly challenging to manage. “The terminal ileum is the most difficult area to heal,” she noted, adding that TNF-α inhibitors have demonstrated high efficacy for ileal disease but still fall short compared with their performance in colonic disease.
Extraintestinal manifestations (EIMs) should also influence treatment selection, especially when targeting systemic inflammation.
Guideline awareness is essential, but clinicians must understand the methodology behind recommendations. “Use guidelines to position therapies, but also understand how those recommendations were developed,” Dr Dubinsky said.
She stressed the need for rational treatment sequencing and transparency in communicating treatment goals with patients. “Surgery is not a failure—it’s a treatment option,” she added.
Mental health and nutrition must not be overlooked. While dietary modification plays a role, it should not substitute for effective medical therapy. Mental health screening should be routine, and perianal disease must be specifically evaluated and addressed early.
“Don't ignore the perianal area. And don’t forget mental health,” Dr Dubinsky concluded. The message was clear: early, personalized, and comprehensive care is essential for optimizing long-term outcomes in Crohn’s disease.
Reference
Dubinsky M. The patient with newly diagnosed Crohn’s disease. Presented at: 2025 AIBD Annual Meeting. December 8-10, 2025.
