Advances in the Treatment of Crohn’s Disease and Ulcerative Colitis

Advances in the Treatment of Crohn’s Disease and Ulcerative Colitis

Obermeier Florian , Schölmerich Jürgen, Strauch Ulrike G
European Gastroenterology & Hepatology Review - Volume 4 - Issue I
Published: January 2009
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Some data also support the use of Escherichia coli Nissle 1917 and Lactobacillus GG for the maintenance of remission in UC, as equivalent efficacy of the probiotic and mesalazine was found.42–44 However, there is no clear evidence suggesting a benefit of probiotic therapy in CD and no placebo-controlled studies have shown a benefit of prebiotics or probiotics in the treatment of active IBD so far. Therefore, although interesting, probiotics require more extensive exploration and validation in large-scale clinical trials.

Treatment with the helminth Trichuris suis was investigated in patients with UC. Compared with placebo, significantly more patients improved after therapy over 12 weeks (47 versus 15%); however, remission was induced in only approximately 10% of patients (placebo 4%).45 Data from an open study on patients with active CD showed better results, as 79% of patients improved clinically and 72% entered remission as observed 24 weeks after the start of treatment.46 Encouragingly, no clinical adverse events have so far been ascribed to the helminth therapy. Certainly, these promising results have to be confirmed in larger placebo-controlled trials and several safety questions (e.g. are life helminths for therapeutic effects necessary? are larvae invasive? how often can the therapy repeated safely?) must be answered before widespread use of this therapeutic concept.

The rise of biologics with the introduction of infliximab in the therapy of patients with IBD offers new medical treatment modalities. However, some patients fail to respond to infliximab and others lose responsiveness during long-term therapy or develop intolerance to the antibody. Also, humanised anti-TNF antibodies do not solve all problems: only 22% of patients show long-term improvement and others develop side effects that limit the use of these medications. As IBD – and especially CD – patients show a wide variety of different genotypes and phenotypes, accumulating evidence suggests that there exist pathophysiologically distinct subsets of patients with IBD. These patient subsets can be expected to respond differently to medications depending on the relative contributions of different pathways; serological markers are therefore needed to evaluate candidate agents and manage patients more effectively in clinical practice. Differentiated, individualised treatments are needed, as patients will most likely not respond to a single strategy.

Therefore, new treatment concepts are still required and studies with new drugs (in part small molecules) specifically inhibiting immune cells within the intestinal mucosa are under way, and seem to be promising. The results of these further clinical trials have to be awaited so these novel compounds can be included in the algorithm for treatment of CD and UC, and continued investigation is pivotal in order to more effectively treat patients with IBD.

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