TNF blockers the future for Crohn's

DIGESTIVE DISEASE CONFERENCE. TNF inhibitors, GORD questionnaire, GI cancer and reflux symptoms.

The monoclonal antibody therapies that have changed the way rheumatoid arthritis is treated - and have posed financial headaches for primary care organisations because of their high cost - are set to do the same in Crohn's disease, GI experts told the Digestive Disease Week (DDW) conference in LA last week.

Currently, Crohn's disease is treated with steroids which reduce inflammatory flares of the disease, but have no benefits in inducing long-term remission.

Aminosalicylate therapy has been found to have no effect in maintaining remission in a recent Cochrane Review.

But clinical trial results suggest that Crohn's patients treated with TNF-alpha inhibitors can reach and maintain remission.

Only the two-hour IV infusion treatment, infliximab, is licensed for Crohn's disease, but treatments likely to be licensed over the next year include certolizumab pegol and adalimumab (Humira) which are given by subcutaneous injections.

A trial of certolizumab pegol, given as a subcutaneous injection once every four weeks, found that after six months, 29 per cent of Crohn's patients were in remission.

Another trial reported that 70 per cent of Crohn's patients responded to treatment with adalimumab. Of these, 46 per cent were in remission after 26 weeks of treatment.

Professor William Sandborn, professor of medicine at the US Mayo Clinic, said: 'We will see a change in how Crohn's patients are treated, and biologicals are going to be more widely used.'

Professor Subrata Ghosh, professor of gastroenterology at Imperial College and the Hammersmith Hospital, predicted there would be a fall in the use of steroids over the next 5-10 years.

'Research suggests that intervention with biologicals at an early stage may be able to slow progression of disease,' he said.

'Crohn's disease affects young people in their teens and 20s. We can expect to modify disease progression and reduce the need for surgery and the development of complications.'

- GPletters@haynet.com

Digestive Disease Week - Live links at GPonline.com.

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