October summary of biologics

Medscape [direct link requires subscription] has released a new summary of the latest findings in biologic therapy for Crohn's disease. Their previous summary on recent anti-TNF research was in June. Although that's still well worth reading, there have been much activity in this area since then.

This article discusses combination therapies, first-line therapy (i.e. should biologics be used earlier in the treatment regime), switching biologics if they become ineffective, safety and newer biologics which have only recently been approved for use. Most of these have been reported in detail previously, but it's handy to have them summarised in one place.

A missing bacterium?

According to the BBC French researchers suspect that a low level of Faecalibacterium prausnitzii bacteria in the intestine could be the cause of Crohn's disease.

The researchers, from the Institut National de la Recherche Agronomique, had already shown that patients with Crohn's disease have a marked deficiency in bacteria from the Clostridium leptum group.

Their latest work shows that F. prausnitzii - a major component of this group - accounts for a large part of the deficit.

If this is true, then treatment would be a simple course of specific probiotics to boost the levels of the bacteria. However, this research is only at the level of cells in test tube. It still has the difficult hurdles of animal and human trials to come.

It's interesting to note that probiotics and antibiotics are both being proposed as possible cures for Crohn's. Although this sounds contradictory, they could both be successful. The probiotic may encourage the growth of certain "good" bacteria which work against "bad" bacteria, whereas the antibiotic works solely on eliminating the "bad" bacteria.

Infliximab more effective than Azathioprine

The Associated Press reports on research that shows Infliximab (Remicade), used alone or in combination with Azathioprine (Imuran) is significantly more effective, and no less safe, than a treatment of just Azathioprine.

Currently, doctors usually prescribe Azathioprine first, and only progress to Infliximab when that fails. This study indicates that Infliximab should be considered earlier. (Note that this study was financed and run by the producer of Infliximab.)

There is more coverage at MedPage Today.

The anti-Crohn's diet

There have been plenty of anecdotal reports of people who have successfully controlled their Crohn's by following specific diets. The Daily Mail mentions the success of a thousand patient trial in a UK hospital.

(...) At Addenbrooke's Hospital, gastroenterologist Professor John Hunter and his team identify foods that act as a 'trigger' for symptoms, eliminate them from a patient's diet and 'switch off' the disease.

Now 90 per cent of his patients are symptom-free and 56 per cent can resume a normal diet after five years.

During the first phase of treatment, patients consume only specially formulated drinks.

'They contain all the nutrients a patient needs, already broken down into their most simple constituent elements so the body does not have to do any work digesting them,' explains Professor Hunter.

'By taking the gut out of action, we effectively switch off the disease. After two to three weeks, 90 per cent of patients find their symptoms have disappeared.'

They then gradually reintroduce different foods to determine which will cause flare-ups in the individual.

This is the first reasonably large trial of using diet alone to control Crohn's that I've heard of. However, it really needs to be expanded into a much larger scientifically-controlled trial to truly ascertain its effectiveness. Unfortunately, most trials are funded by drug companies, and a diet solution to Crohn's wouldn't offer any profit for them. On the other hand, I'm sure there would be no shortage of volunteers for the trials, and doctors willing to assist.