Thursday, November 28, 2013

Weekend Links: Thalidomide Crohn's Remission, Humira More Effective After Surgery, Delay in Crohn's Diagnosis and Greater Risk of Surgery, Leukocyte Apheresis Helps Crohn's in UK

Thalidomide Clinical Remission for Pediatric Crohn's Patients
So it appears according to this study that thalidomide helped improved the condition of Crohn's patients. The study involved 56 children and was conducted over a 4 year period. Basically the trial showed that the true benefit for thalidomide came 2 months after the dosage was initially started (no change after the first month). Overall a little over 63% of the children achieved clinical remission which is quite impressive. What is even more impressive is that clinical remission was achieved for almost 3 and half years (181 weeks). Thalidomide  for Crohn's has been studied for a while with even positive results yet it is curious why more trials haven't been conducted given the good results. Here is a case of a 31 year old executive secretary woman who had severe Crohn's for 15 years (was on 6-MP and drugs like Prednisone) and then took thaldomide for erythema nodosum and her Crohn's went into remission (interesting how experimentation works). She according to the article was in remission for 4 years. Here is another study from 2011 that reached a similar conclusion that thalidomide was useful for pediatric Crohn's. Perhaps thalidomide needs to be used more to see if it can really help more patients with Crohn's.

Humira More Effective than Azathrioprine & Mesalamine After Resection for Crohn's
This study in the November 2013 issue of American Journal of Gastroenterology showed that Humira (Adalimumbab) had a lower endoscopic recurrence (12.4%) than Azathrioprine (65%) or patients taking mesalamine (50%). The quality of life was also highest for patients taking Humira after the surgical resection.

Delay in Crohn's Diagnosis = More Complicated = Greater Risk of Needing Surgery 
So this study studied 905 Crohn's patients and placed the patients into various categories depending upon when patients were diagnosed. What researchers found was that the longer patients waited to get diagnosed was correlated with a surgery required. This may be a situation were correlation and causation are running the same direction given the more damage Crohn's is causing to your intestines the less likely it is they can be healed. I was lucky in that my gastro doctor made the correct diagnosis within 3 weeks. Hopefully we can develop better testing to distinguish between different digestive diseases.

Leukocyte apheresis helps first Crohn's patient in United Kingdom
A 24 year old guy who failed both medical and surgical therapy used leukoctye apheresis treatment which lead to a successful treatment. Basically apheresis is removing blood from the patient taking the blood and separating into different parts (using a centrifuge) and the blood is then retransfused into the patient (stem cells are done in this way often times).

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