Tag: crohns disease

10 Apr 2018

Crohn’s Disease: Heading Toward its 100th Birthday

Could a cure for Crohn’s disease be in the future? There are several research directions that are moving forward with hopeful results, although a “cure” appears to remain an unsatisfying way in the distance. Crohn’s disease – as a specific type of inflammatory bowel disease – was first described back in 1932. As we head toward the centennial of naming this disease, researchers continue to work hard on new treatment options, as well as the long hoped for cure, by that anniversary.

Since 1932, the core treatment options for Crohn’s disease have included corticosteroids, aminosalicylates, thiopurines, and methotrexate. Only in the past two decades did new therapy agents start to appear: three tumor necrosis factor antagonists, two anti-integrins, and an anti-interleukin 12/23 antibody. Clearly, however, much work remains to be done, since as many as 25% of patients do not respond to these treatment options.

This is where an investigational once-daily, oral medication comes in: filgotinib, which is being developed by Galapagos. Filgotinib is a selective JAK1 inhibitor. JAK1 is an enzyme necessary in the inflammation process. Early research indicates effectiveness of filgotinib in the treatment of moderate-to-severe Crohn’s disease.

In one study, the group of 128 Crohn’s disease patients taking filgotinib found that 47% reached clinical remission by week 10 of treatment (compared to 23% of the placebo group). This is the most hopeful outcome that’s been seen in research for quite some time. Additional research continues to be conducted with filgotinib, including for long-term safety.

Sources

A cure for Crohn’s disease by 2032. Lancet 2017;389:226.

Ananthakrishnan AN. Filgotinib for Crohn’s disease—expanding treatment options. Lancet 2017;389:228-9.

Vermeire S, Schreiber S, Petryka R, et al. Clinical remission in patients with moderate-to-severe Crohn’s disease treated with filgotinib (the FITZROY study): results from a phase 2, double-blind, randomised, placebo-controlled trial. Lancet 2017;389:266-75.

06 Mar 2018

Personalizing Crohn’s Disease Treatment

Guest blog by: Marianne Shenouda, Pharm.D., Clinical Pharmacy Specialist, BioPlus Specialty Pharmacy

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, are chronic inflammatory diseases of the bowel. These diseases can develop as a result of genetic or environmental factors, such as smoking, diet, or any alteration of the normal human gut flora. These factors spur a progressive immune response, which in turn creates mucosal damage to the GI tract.

Symptoms of inflammatory bowel disease run the gamut from diarrhea, abdominal pain, and perianal fistulas to fatigue, weight loss, and/or bowel obstruction. While ulcerative colitis is more closely associated with changes to the inner lining of the colon, Crohn’s disease can affect any segment of the gastrointestinal tract: all the way from mouth to anus.

Treatment for Crohn’s disease focuses on two main types of medications: anti-inflammatory agents and biological treatments. The biological treatments include many medication options: Humira, Remicade, Cimzia, Stelara, Entyvio, and Tysabri. These medications work to alter the immune response of the immune system, by targeting specific proteins that cause inflammation. Humira, for example, targets a protein called TNF-alpha.

Crohn’s disease biological medications can bring great benefits to patients; but unfortunately it is not uncommon for a particular medication to become less effective over time. However, monitoring certain elements of the immune system can guide future treatment. Specifically, monitoring levels of adalimumab antibodies (ATAs) can allow determination if a patient needs a dose increase or if it is appropriate for the patient to switch to another medication within the same drug class. It appears that low trough concentrations may be reflective of a loss of response to Humira (trough levels less than or equal to 5 mcg/ml). In this case, testing for antibodies is suggested. For trough concentrations above 5 mcg/ml, the presence of antibodies are not likely, so the patient may benefit from an increased dose. It was also suggested that adalimumab concentration results above 35 mcg/mL should be drawn at a different time-point other than trough.

Overall ATA testing could lead to a more appropriate and cost-effective management strategy for patients with Crohn’s disease, which is part of an overall move to more personalized treatment of disease.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991576/

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/64863