Infliximab may soon be subsidised in Australia

The Australian Pharmaceutical Benefits Advisory Committee has recommended that Infliximab (Remicade) be subsidised for the treatment of Crohn's disease (it's already subsidised for other conditions):

The PBAC recommended the listing of infliximab for the treatment of patients with severe Crohn’s disease (Crohn’s Disease Activity Index ≥ 300) or patients with an ileostomy or colectomy due to Crohn’s disease on the basis of a high but acceptable cost-effectiveness ratio compared to placebo. Acceptable cost-effectiveness was demonstrated at a dose of 5 mg/kg infliximab for three doses (weeks 0, 2 and 6) and when continuation of treatment beyond three doses was determined by remission (CDAI ≤ 150) at approximately 12 weeks from the commencement of treatment.

As noted by the Sydney Morning Herald it still has to be approved by the government. If they do so, then the cost per injection will be reduced from $4000 to a much more manageable $30.

Genome discoveries

Hot on the heels of the US and Canadian gene findings is another genome-led research article, this time from Belgium. You can read the very technical article online in full at PLoS Genetics. I present the author summary in full here, because the article itself is too complicated for me to summarise:

Individual susceptibility to many common diseases is determined by a combination of environmental and genetic factors. Identifying these genetic risk factors is one of the most important objectives of modern medical genetics, as it paves the way towards personalized medicine and drug target identification. Recent advances in SNP genotyping technology allows systematic association scanning of the entire genome for the detection of novel susceptibility loci. We herein apply this approach to Crohn disease, which afflicts an estimated 0.15% of the people in the developed world and identify a novel susceptibility locus on Chromosome 5. A unique feature of the novel 5p13.1 locus is that it coincides with a 1.25-Mb gene desert. We present evidence that genetic variants at this locus influence the expression levels of the closest gene, PTGER4, located 270 kb away, in the direction of the centromere. PTGER4 encodes the prostaglandin receptor EP4 and is a strong candidate susceptibility gene for Crohn disease as PTGER4 knock-out mice have increased susceptibility to colitis.

More Crohn's genes found

It has now been conclusively shown that genetics plays a role in the development of Crohn's disease, with the release of a study in Nature Genetics (full article available for purchase for US$30). Data from the Human Genome Project was used to compare the genes of people with and without the disease. The ABC mention:

Scientists previously had some indications of a genetic component to Crohn's disease. It tends to run in families and is more common in certain ethnic groups, especially people of central and eastern European Jewish descent.

Pinpointing the genes that predispose people to Crohn's disease could help lead to new ways to treat it, say the researchers.

Amongst all the other areas of research into Crohn's, we shall now have to keep an eye on developments in gene therapy.