Wednesday, April 11, 2012

Low Dose Naltrexone Treatment for Crohn's?

One medication that currently is not approved for treatment in Crohn’s is low dose naltrexone (also known as LDN). People have claimed it can help patients with Crohn’s. Others say it is wishful thinking. I like to evaluate things based off evidence and facts and from what I have seen LDN seems like it could be another tool doctor’s use in the battle against Crohn’s.
Dr. Jill Smith professor of gastroenterology at Penn State University’s College of Medicine has done some studies looking at the effectiveness of LDN. One study in the April 2007 American Journal of Gastroenterology found that 67% of patients who took LDN went into remission.  What is even more remarkable is that 89% of patients had some type of response to the treatment. These results were statistically significant meaning they were not due to just chance alone. There was also endoscopic evidence meaning when a colonoscopy was performed there was less inflammation and mucosal healing.
In another study published in 2011 entitled “Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn's disease: a randomized placebo-controlled trial” Dr. Smith and her colleagues found that 88% of those treated with LDN saw a drop in their CDAI scores. Also after 3 months, 78% of patients had endoscopic evidence showing improvement. Fatigue was the only side effect reported. Over half the patients who failed or couldn’t handle biologics were enrolled in this study.
Naltrexone itself has been around since 1992 when it was used for people who were alcohol dependent. It is important to point out that people who take naltrexone for alcohol dependence take a much higher dose (100mg) as opposed to low dose naltreone which is only 4.5 mg. The side effects of LDN should be much less than the regular version.  It would be interesting to see if increasing the LDN higher would create even better results in patients.
The data is in and it looks like LDN could provide help for Crohn’s patients. Although, more studies and long term safety data have to be evaluated naltrexone can be prescribed however this is considered an “off-label use”. Dr. Jill Smith and a colleague have the patent for naltrexone in people who have inflammatory bowel disease. Remember just because a drug gets approved doesn’t mean it is approved for all illnesses and diseases.  If a drug is safe and has been around for two decades why on earth are people not allowed to take LDN?
My own view is that once the FDA deems a drug safe (Phase I) people should be allowed to take it to determine the drug’s effectiveness. Millions of people are suffering in pain because the FDA won’t let them consume drugs that could help.  Everyone has different body chemistry and reacts differently. I would rather have this then the FDA make blanket statements saying this group or that group can’t consume a drug.  

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