How Close Are We to a Cure for Crohn’s Disease?

 Researchers are looking for new ways to treat symptoms of Crohn’s disease symptoms, as well as possible cures. Newer treatments are using medications that block inflammation at the source rather than after the inflammation has occurred.

Researchers are also trying to uncover treatments that are more specific to the intestinal tract.

Here, we take a look at drugs in the pipeline that may be effective at helping to treat symptoms or even prevent or cure Crohn’s.

Also, we review the existing treatments available.

Though there are treatments, there’s currently no cure for Crohn’s disease. Treatment goals are to reduce symptoms due to inflammation and limit any complications.

If treatment works, it can lead to:

  • symptom relief
  • reduced symptoms
  • remission

In 2020, a research group found a microscopic marker that could help identify people who are likely to have an inflammation recurrence. This could allow therapeutic intervention at an earlier stage.

This type of symptom prediction has the potential to improve long-term symptom relief for people with Crohn’s.

RHB-104 is one of the promising new drugs in the pipeline.

Some 2016 researchTrusted Source suggests that having an infection with a bacterium called Mycobacterium avium paratuberculosis (MAP) may contribute to Crohn’s disease as well as other human diseases.

Studies are ongoing to uncover the exact role of the MAP bacterium in Crohn’s disease, as not all researchers agree. It seems that only some people with Crohn’s disease have a MAP infection, and some people with a MAP infection do not have Crohn’s disease.

The bacterium causes serious intestinal infections in cattle, similar to Crohn’s disease in humans. As a result of this knowledge, several studies are underway to see if antibiotics that treat MAP help people with Crohn’s disease.

The first clinical trial of RHB-104, an antibiotic cocktail of clarithromycin, rifabutin, and clofazimine, was completed in the summer of 2018 and reported results. A link between RHB-104 and clinical remission was shown to be statistically significant.

Researchers found that 44 percent of people with Crohn’s disease who took RHB-104, along with their existing medications, had a significant decrease in symptoms after 26 weeks. In the placebo group, 31 percent had a similar decrease.

At 1 year, the rates were 25 percent and 12 percent for the two groups, respectively.

While the results are promising, more studies are needed. The study didn’t identify which study participants had a MAP infection. Also, it’s not clear whether RHB-104 helps people achieve remission or how the drug compares to other medications used for Crohn’s.

phase I study has shown promise for an oral, ATP-competitive, JAK1 selective inhibitor called AZD4205. It was tested on animal subjects and healthy human volunteers, and it was well tolerated with no drug-related negative effects so far.

A phase II study involving participants with moderate to severe Crohn’s disease is in the works.

A year-long study conducted between 2018 and 2019 in the United Kingdom was designed to study the safety of an anti-MAP vaccine for humans. A total of 28 volunteers were recruited from Oxford, England.

The protocol involves two different vaccines and various doses of each. Only after safety is established can researches do a randomized trial on effectiveness.

If it is deemed effective, it could be 5 to 10 years before it becomes available.

Currently, there’s no known cure for Crohn’s disease. Treatment for the condition traditionally focuses on reducing symptoms. It’s also sometimes effective at bringing a person’s Crohn’s disease into long-term remission.

Most of the time, Crohn’s is treated with medications. The first-line approach to reducing Crohn’s symptoms is to reduce inflammation in the bowel. In some cases, doctors will recommend surgery to help ease symptoms.

One or more of the following treatments are usually used:

  • anti-inflammatory drugs
  • immune system suppressors to help reduce bowel inflammation
  • antibiotics to help heal ulcers and fistulas, and to help reduce the number of harmful bacteria in the intestines
  • fiber supplements
  • pain relievers
  • iron, calcium, and vitamin D supplements
  • vitamin B12 shots to help reduce risks of malnutrition
  • nutritional therapy, such as a special diet plan or liquid diet to help reduce risk of malnutrition
  • surgery to remove damaged parts of the digestive system for symptom relief

Anti-inflammatory drugs

Corticosteroids, such as prednisone, have long been beneficial for people with Crohn’s disease. However, they’re limited to short-term use when other treatments aren’t effective. This is because they can have many serious side effects on the entire body.

2012 review of studies suggests that more recently developed corticosteroids, such as budesonide and beclomethasone dipropionate, may be more effective at reducing symptoms, with fewer side effects.

More research is needed to determine if budesonide and belomethasone are actually more effective at reducing symptoms.

Immune system suppressors

Common immune system suppressors that have been traditionally used to treat Crohn’s disease are azathioprine (Imuran) and mercaptopurine (Purinethol). But research has found that they can cause side effects, including increased risk of infection.

Another drug in this category is methotrexate, Typically, it’s used in addition to other medications. All of the immune system suppressor drugs require regular blood tests to monitor potential side effects.

Biologics

Newer drugs, called biologics, are used to treat Crohn’s disease in people with moderate to severe cases. Depending on an individual’s overall health, not everyone may be a candidate for these medications.

TNF inhibitors

TNF inhibitors work by blocking a protein that causes inflammation.

Some examples include:

  • infliximab (Remicade)
  • adalimumab (Humira)
  • certolizumab pegol (Cimzia)

Two additional examples of TNF inhibitors are adalimumab-atto (Amjevita) and adalimumab-adbm (Cyltezo), which are both FDA approved biosimilar drugs to Humira.

It’s important to note that researchers have also found that for some people, TNF inhibitors may become less effective over time.

ResearchTrusted Source in this area continues to progress.

Natalizumab (Tysabri) and vedolizumab (Entyvio)

These drugs are also used to treat moderate to severe Crohn’s disease in people who don’t respond well to other medications. They block inflammation in a different way than TNF inhibitors. Rather than blocking TNF, they block a substance called integrin.

They work by keeping inflammatory cells out of tissue. Natalizumab (Tysabri), however, carries a risk for developing a serious brain condition called progressive multifocal leukoencephalopathy (PML) in certain people. It’s recommended that people get tested for the JC virus before using this medication in order to reduce this risk.

ResearchTrusted Source published in 2016 suggests that vedolizumab works similarly to natalizumab, but so far it does not have the same risk of brain disease. Vedonlizumab seems to work more specifically on the intestinal tract rather than the whole body.

More research is needed to definitively determine if vedolizumab is safer than natalizumab.

Ustekinumab (Stelara)

Ustekinumab (Stelara) is the most recent biologic approved to treat Crohn’s. It’s used in the same way as other biologics. A studyTrusted Source published in 2016 suggests that it may be helpful in treating Crohn’s disease when other medications don’t work.

This drug works by blocking certain pathways of inflammation. However, in rare instances it can also affect the brain.

Stem cells

Since reducing inflammation is often the goal for Crohn’s symptom relief, research has targeted mesenchymal stem cells (MSCs) as a strong anti-inflammatory tool.

2020 study on bone-marrow-derived mesenchymal stromal cell therapy showed long-term improvement in perianal Crohn’s disease fistulas.

More studies are needed to determine the effect of stem cells on symptoms of Crohn’s disease.

Diet

There are linksTrusted Source between the gut microbiome and inflammation.

recent study of a microbiome-targeting diet called the IBD-Anti-Inflammatory Diet (IBD-AID) showed that 61.3 percent of patients following the diet for at least 8 weeks reported a dramatic decrease in severity of symptoms.

The diet focuses on probiotic and prebiotic foods and avoiding:

  • trans fats
  • processed foods
  • dairy
  • foods that contain lactose, wheat, refined sugar, and corn

As our understanding of Crohn’s disease continues to improve, we can expect more effective treatment options in the future.

Having a specialist in Crohn’s as part of your medical team is one way to ensure you’re receiving accurate information about your disease, as well as keeping up to date on any new treatment options.

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