Crohn’s disease and ulcerative colitis are diseases that causes the lining of one’s gastrointestinal (GI) tract to become inflamed. It is two of the main forms of inflammatory bowel disease (IBD). While there are currently no known cure for Crohn’s disease and ulcerative colitis, there are many therapies that are available to treat these diseases.
With the help and advancement of medical research, and a better understanding on how Crohn’s disease and ulcerative colitis develop, there are also more treatments/therapies that are being developed.
Current Therapies
For more than 20 years, anti-tumor necrosis factor (anti-TNF) medicines have been used to treat immune-mediated inflammatory diseases, including Crohn’s and colitis. Anti-TNF work by limiting the activity of the TNF, one of the main components of causing your body’s pathways to become inflamed. However, treatment using the anti-TNF have a number of side effects, such as an increased chance for serious skin and soft tissue infections. As such, anti-TNF therapies must be carefully monitored.
Despite its side effects, treatment using anti-TNF will continue to be an important way to manage Crohn’s and colitis.
Recently Approved Therapies/Treatments
Vedolizumab
A new gut-specific monoclonal antibody called vedolizumab has shown favorable results in treating both Crohn’s and ulcerative colitis. Vedolizumab help control inflammation as well as treat other symptoms of Crohn’s and colitis by preventing white blood cells from entering the GI tract. Because of the way vedolizumab localize and target this prevention, the antibody has the potential of treating Crohn’s and colitis without affecting the immune system of the rest of the body; as a result this can significantly lower the chances of getting infections outside the bowel.
Using vedolizumab as treatment has been approved in Canada for adult patients with moderate to severe active ulcerative colitis. These patients must be intolerant or do not respond to anti-TNF treatment. In the United States, use of vedolizumab as treatment has been approved for adult patients with moderate to severe Crohn’s disease and/or ulcerative colitis. These patients must have failed or are intolerant to one or more of the standard therapies used to treat Crohn’s and/or colitis — such as steroids, immunomodulators, and/or anti-TNF medicines.
Vedolizumab is given intravenously (through an IV).
Other medications that are similar to vedolizumab such as etrolizumab, AJM300, AMG181, and PF-00547659, are currently in clinical trials.
Ustekinumab
This is a monoclonal antibody that is currently used to treat autoimmune conditions like plaque psoriasis and psoriatic arthritis. It works by targeting molecules called cytokines (IL-12 and IL-23) that causes continued inflammation that occur in Crohn’s disease.
In one study, treatment using ustekinumab lead to higher rates of clinical remission and response (41.7% vs 27.4% and 69.4% vs 42.5%, respectively) in patients who had previously been unresponsive or intolerant of anti-TNF treatment. However, ustekinumab can cause some serious side effects, including increased risk of infection and/or certain types of cancers. Additionally, no study has been done on the side effects the drug may have on pregnancies and/or fertility.
The U.S. Food and Drug Administration (FDA) has very recently, in September 2016, approved of ustekinumab for treatment of Crohn’s.
Promising Therapies In Progress
Tofacitinib works to block certain molecules that contribute to inflammation. It has been approved to treat rheumatoid arthritis, and is currently being studied to treat ulcerative colitis. Its most recent study, which started in 2012 and was completed in 2015, was noted as “a significant milestone” in treating those with moderate to severe active ulcerative colitis.
Despite its success, it is important, however, to keep in mind some side effects of tofacitinib, which includes an increased risk of infection. As well, tofacitinib has not been approved by European regulatory agencies due to concerns over its effectiveness as well as safety.
Therapies in Early Stages of Development
Stem Cell Therapies
There are a few stem cells therapies that are in development to treat Crohn’s. They are called hematopoietic stem cell transplantation and mesenchymal cell infusions. Both hematopoietic cells and mesenchymal cells can differentiate into a variety of cells; thus stem cell therapies can potentially reset the body’s immune system.
Though these therapies show promising results in treating the most severe forms of Crohn’s, there are only a few studies done using this type of therapy. There are potentially significant side effects such as continued use of immunosuppressive drugs and higher risk of infections that has been noted. More studies need to be made before deciding whether or not stem cell therapy can be an effective and safe way to treat Crohn’s.
Chemokines
Chemokine and chemokine receptor antagonists has shown a high increase in clinical remission and response for patients with inflammatory bowel diseases (IBD). They work by blocking white blood cells from the gut mucosa, thus reducing inflammation. Despite its success, further studies need to be made to determine safety as well as effectiveness of using chemokine to treat IBD.
HMPL-004
HMPL-004 (Andrographis paniculata extract) has been shown in studies done on animals to have anti-inflammatory properties. As a result, studies have been done in using this drug to treat patients with mild-to-moderate ulcerative colitis. Patients who have used this drug has shown great clinical response, however further studies need to be made to assess if this drug can treat severe ulcerative colitis as well.
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