Progress Reported for Crohn's Disease

"Progress has been made in the treatment of Crohn's disease," says Dr. Alan Buchman, associate professor of medicine, division of gastroenterology, hepatology and nutrition at The University of Texas-Houston Medical School.

Crohn's disease is a chronic illness that causes severe inflammation and ulcers throughout the gastrointestinal tract. This may include the mouth, esophagus, stomach, intestine, colon and rectum. Symptoms may include abdominal pain, bleeding, weight loss, fatigue and arthritis. The disease affects an estimated 750,000 to 1 million people in the United States. About 20 percent of patients have disease that is resistant to standard, currently available treatments. In addition, treatment with current medications may be associated with significant side effects.

A clinical trial conducted by Dr. Buchman with infliximab, a new drug that should be available for use by mid-October, decreased the number and size of fistulas significantly. Fistulas are abnormal connections that a patient may develop from the intestine to the skin or other organs. Infliximab has now been approved as the first drug to reduce the number of fistulas in Crohn's disease in a controlled trial. Other studies have shown it is also effective for Crohn's disease that is resistant to treatment with steroids.

"Infliximab is the first major advancement in the treatment of Crohn's disease in 20 years," Dr. Buchman adds. Treatment using infliximab will consist of one to three two-hour intravenous infusions of medication.

The actual cause of Crohn's disease is unknown, although there is a slight genetic risk for the disease and there may be environmental triggers as well. These factors lead to the release of a complex cascade of pro-inflammatory and anti-inflammatory substances from white blood cells. One of the initiators of this cascade is tumor necrosis factor (TNF). This substance causes the white blood cells to release additional pro-inflammatory substances, called cytokines, that cause the symptoms of Crohn's disease. If the actions of TNF can be blocked, inflammation may be decreased significantly and patients may find relief. Infliximab is a genetically engineered antibody that blocks the release of TNF.

Comments Dr. Stephen Hanauer of the University of Chicago Medical Center department of gastroenterology and a principal investigator in the clinical trials, "These patients suffer terribly and with infliximab we physicians now have an important option available to treat them."

Dr. Buchman cautions that not all people respond to the treatment, and he is currently involved in research on other medications to treat resistant Crohn's disease and ulcerative colitis. He is investigating medications that may block the release of pro-inflammatory cytokines, as well as giving anti-inflammatory cytokines (similar to those naturally made by the body) to patients.

For more information about Crohn's disease, call the Crohn's and Colitis Foundation of America at 1-800-343-3637 or visit www.centocor.com or www.ccfa.org.

- From The University of Texas-Houston Medical School

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©2006 Texas Medical Center

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