Top 2013 Crohn's Stories

So this year has been a very interesting year in terms of Crohn's research. Here are my top Crohn's/IBD stories for 2013...

Possible Crohn's Cure: Anti-MAP?
     There has been a long debate as to what actually causes Crohn's. There are multiple theories but one theory by Dr. Saleh Naser at University of Central Florida (he has been studying this since 1995) is that a bacteria known as mycobacterium pratuberculosis (MAP for short) is what causes Crohn's. It is believed that 40-50% of patients have MAP in their bodies. In order to fix this RedHill Biopharma is licensing Dr. Naser's technology to develop RHB-104 to treat Crohn's. Redhill Biopharma is already conducting Phase III clinical trials and results won't be expected until 2015-2016. However, if this drug really was a cure I could see the drug being brought to the market very quickly. I personally believe this treatment would help me more since my Crohn's started around the same time I had bronchitis and the only flare up I had was when I took an antibiotic which leads me to believe that antibiotics are what seem to be creating the issues.

Vedolizumab Works For Ulcerative Colitis (UC) 
     A new blockbuster drug may be coming soon to a drug store near you. In this trial 47% of patients responded to the drug (compared to a 26% placebo rate). Clinicial remission was about 42% after one year (which is pretty good). There were difference in adverse effects in the placebo group compared to the patients that received the drug. The results for Crohn's disease were mixed. However, once if the FDA approved vedolizumab for UC then doctors may try it with certain types of Crohn's patients to see if it works. The FDA can only regulate drugs and not the practice of medicine.

Cold Water Helps Guy Get Off All Drugs For Crohn's
     Probably the coolest (pun intended) was the story about a guy (Robb Starr) who jumped into chilly water which immensely helped his abdominal pain related to Crohn's. This story lead me to conduct my own research and I did feel quite amazing right after a cold swim (your body does get use to the water after a few minutes). He even woke up at 3 a.m. in pain and went for a swim which after a few minutes would make him pain free. Six years ago he stopped taking all medications and now is not taking anything. Maybe researchers can actually study this by measuring inflammation markers before and after and have patients take a cold swim for 6 months and do a before and after colonoscopy along with some CDAI scores.

Thalidomide Helps 46% of Pediatric Crohn's Achieve Remission
     Perhaps one of the better stories this year was thalidomide showing that it is effective in Crohn's. The trial was  done for just 8 weeks but done over a 4 year period. Longer term studies are needed to study the side effects of thalidomide to see not only if it can induce remission but to make sure it is safe.

Pigworms Failed For Crohn's
     Unforuntately we learned that Cornado's pigworm treatment for Crohn's didn't live up to its promise. I did a full post on Coronado Biosciences here. The trial didn't met the clinical endpoint (drop of 100 points in CDAI). However, it should be noted that patients with a high CDAI (>290) did show an improvement. Prior studies have shown pigworms to be quite effective. With this study showing 86% remission for Crohn's and this study showing 80% of patients had a response.

The good news for the pigworms was that came from initial data that showed the treatment may benefit patients with autism (it is believed that autism is autoimmune as well). Results from this trial are expected by the middle of 2014. The study was only 5 autistic patients however they showed much improvement in their symptoms. The Coronado Biosciences stock was up 33.7% that day as a result of the good news. The company is currently conducting studies for the pigworms in psoriasis patients and results are due out in first quarter of 2014.  In essence, Coronado just has to hit one major disease (psoriasis, Crohn's, multiple sclerosis) to be a hit.

Fecal Transplant Effective in 67% With Ulcerative Colitis, 33% Show No Signs Of Symptoms After 
     I mentioned in this post how fecal transplants were effective in patients with ulcerative colitis. In the study done by Dr. Sachin Kunde 78% of patients achieved a clinical response within one week and 67% of patients maintained a response after one month. What is very interesting is 33% of patients didn't show any symptoms of ulcerative colitis after their fecal transplant. The study was only limited to children and there were only five infusions. I would suspect if you continued to do fecal transplants (via enema) you may have more success.

Biologics Reduce Stomas by 33%
     Patients with Crohn's always wonder about whether or not they will need a stoma. This study looked at patients who had surgery before biologics (pre 2002) and those who had biologics (post-2002). 61% of patients in the pre-biologic era had a permanent stoma while only 20% of patients in the post-biologic era had stomas. This study from the early 1990's shows that only about 7% of Crohn's patients require a permanent stoma and 20% require a temporary stoma. However, in the early 1990's minimally invasive surgery was just coming on to the scene which would reduce the percentage of stomas required and pre-biologics which are now reducing the number of stomas required.

Weekend Links: Capsule Endoscopy in Crohn's (Japan), Pig-Worm Treatment for Autism?, Stem Cell Trial for Crohn's

Capsule Endoscopy in Crohn's Patients (Japan)

This recent study (to be published in Jan 2014) shows that capsule endoscopy can be useful in evaluating small bowel mucosal injuries. However, patients with intestinal strictures should be careful (capsule could get blocked which would lead could lead to an emergency trip to try to remove the capsule. In this related paper it only takes about 10 cases of capsule endoscopy images for a doctor to become proficient in it.

Pig-Worm Treatment for Autism?

So Coroando Biosciences this year has had an interesting year. First the stock seem to run up after excitement about the trial they were doing with TSO-pigworms for Crohn's (however the data later came out showing there was no benefit). Now we learn that the same company seems some good results for patients with autism (there were only 10 patients in the study). It is believed that autism is autoimmune (this is controversial). If the FDA approves TSO pigworms for autism it could allow more patients to experiment with it for Crohn's (since once a drug is approved by the FDA the FDA can't ban what a drug is used for).

Stem Cells Trial at Emory University for Crohn's

Emory University in Atlanta, Georgia is conducting a trial using mensenchymal stromal stem cells from patients. So the cells are taken from the Crohn's patient and then processed (I have usually seen this done via centrifuge) and then the cells are placed back into the patient. Taking stem cells from a stranger isn't as effective since you don't have their immune system which results in a live-long course of drugs that suppress the immune system. For more information you can call (404)-727-7049. 

Weekend Links: Diet Helps Crohn's Woman, Fecal Transplant Helps Crohn's Patient With Fistula, Jog May Keep Crohn's At Bay, Possible Cure For Crohn's?

Diet Helps Woman With Crohn's
So here is a story about a diet that helped a Crohn's patient. Tara Rosas was having issues with Crohn's and when she was told she would need surgery she tried changing her diet and actually is now in remission. She eliminated all grains, potatoes, and certain sugars and began eating spinanch, celery, carrots, apples, and lemons. After 7 months she was symptom free (I would love to see a colonoscopy before and after and was able to stop all types of medications. She has been in remission for 3 years. It can be tricky because sometimes people can go into remission for years and maybe not even me on medication and be fine.

Fecal Transplant Helps Crohn's Patient With Fistula 
Here is a case study that showed how a fecal transplant helped someone with refractory Crohn's disease (patient had a fistula).  The patient was a 32 year old Chinese man who had Crohn's disease. A CT scan in the patient showed an abdominal mass. A fecal transplant was performed (mid-gut) and a week after the fecal transplant the patient no longer had a fever, bloody stool, or abdominal pain, and his mass became smaller. His CDAI score decreased from 537 to 228. After three months his CDAI score dropped to 62 (remission).

Jog A Day May Keep Crohn's At Bay
So this recent study looked at women (194,000) over a long period of time (between 1984-2010). The studies conclusion is that "physical activity was inversely associated with risk of Crohn's disease but not ulcerative colitis". This is interesting because I partly have a theory that my insane workout routine pre-Crohn's may have lowered my immune system and possibly lead to met getting Crohn's disease. What studies like this fail to do is look at what caused what. Exercise in some people may increase or decrease risk of Crohn's (it depends on the person since everyone is different). The next study that should be done should try to answer the why.

Possible Crohn's Cure? Anti-MAP
So I probably have discussed this before on this blog but Dr. Naser at University of Central Florida is doing some interesting work in trying to possibly develop a cure for Crohn's. Naser has been at UCF since 1995 and been studying Crohn's for about 18 years. There will be no doubt that the upcoming clinical trial he has started will see once and for all whether or not MAP causes Crohn's disease (I hope it does because if so it could be a large breakthrough for Crohn's patients). Redhill Biopharma is already conducting Phase III clinical trials. Results probably won't be expected for 2-3 years (although if patients really were cured they would most likely suspend the trial and allow patients who suffer to take the medication).

Weekend Links: Smoking, Fecal Transplants for IBD, Remicade Generic, Crohnology, and Lasers for IBD

Smoking and Crohn's 
     This article studied people who smoke and use to smoke and found that patients who smoked required more treatment that non-smokers. Smokers were more likely to have strictures, receive steroids, immunosuppressants, or on anti-TNF drugs (this tells me the smokers had more moderate to severe cases of Crohn's). Last year I did a post showing that showed that smokers were more likely to require surgery than non smokers (80% increase actually). Also in that post I mentioned that at 10 years the need for repeat surgery was only 41% for nonsmokers and 70% for smokers. The policy recommendation would be to obviously stop smoking.

Fecal Transplants Treating Bowel Diseases
Early data from a study out of Canada shows that fecal transplant may help people with inflammatory bowel disease (IBD). Canada actually has the highest rate of Crohn's disease in the world. The study plans to look at 120 people (as I write this 60 patients have been treated so far). Patients are using enemas in this trial. Dr. Paul Moayyedi said that some patients have done extremely well so far and one patient was in remission for 6 months. Patient Anna Fernande has been in remission since last fall (she has ulcerative colitis). Personally I believe fecal transplants will help the people with ulcerative colitis more than Crohn's. Perhaps researchers can study why this is the case.

Remicade Going Generic?
It looks like Remicade might be going generic in Europe at least. Drug companies are given a patent to market and sell a particular drug for a decade. However, after this time period a drug then become a generic and usually the cost is substantially less. The generic and the real drug made are on the molecular level however in practice and be a little different. However, with biologics this is trickier to do since you aren't replicating a pill. Inflectra would be what is known as a biosimilar to Remicade. What is interesting is in a trial of people with rheumatoid arthritis patients actually did better under Inflectra (the biosimilar) than Remicade the more expensive drug! Inflectra also showed that is had similar side effects as Remicade. Estimates show that biosimilars could save patients $23 billion by the year 2020. However, one issue is this would only be approved in Europe and not the United States. Perhaps we should have some reciprocal approval program to where if a drug is approved in one country it can be approved in other countries.

Crohnology: Crohn's Patients Helping Other Crohn's Patients
This is a pretty good article on a website Crohnology (which I am a member of) were people with Crohn's and ulcerative colitis discuss what they prescriptions they are on and how they deal with Crohn's. The website is powerful in terms of you can track your health everyday and get a text message that asks how you are doing. Crohnology was founded in 2011 and already has over 4,200 people. Patients helping others is wonderful and there may be important knowledge in Crohnology that researchers could use to better understand this horrible disease.

Laser Peers Through Intestinal Walls
A new laser could be used to help determine if a patients needs a colonoscopy or biopsy. The technology can give doctors a more focused approach to where the biopsy needs to take place instead of guessing.

Weekend Links: ChemoCentryx Drug Crohn Failure, Chronic Bowel Disease Increases in UAE, Vedolizumab Remission

ChemoCentryx SHIELD-1 for Verniron Fails
     The drug company ChemoCentryx that their drug verciron (chemokine receptor CCR9) really didn't help patients with Crohn's disease. The clinical endpoint is was whether or not patients has a decrease of at least 100 points in their CDAI score after 4 months. 608 patients were enrolled in the study (which is not only timely but very costly). Vercirnon was suppose to launch in 2016. Vercirnon was an oral drug and had lower costs associated with it since it wasn't a biologic which are much more expensive according to this article.

Bowel Disease Increasing In UAE
     It appears that doctors in the UAE are seeing a rise in the amount of inflammatory bowel disease. Dr. Nathwani has said he has seen a 10%-15% increase since 2007. Dr. Nathwani sees about 3 or 4 new patients every week with IBD every week. Dr. Kataa says that white people who are young are a higher risk of getting it. Perhaps one theory which I might believe to be true is the clean hypothesis which basically states that autoimmune diseases are on the rise because we might be in fact too clean which explains why developed countries have seen an increase in autoimmune diseases while undeveloped countries with more parasites have fewer cases of autoimmune disease. The pigworm drug trials will shed more light onto this.

Vedolizumab Helps Remission for Ulcerative Colitis
According to this study from the New England Journal of Medicine. The medicine actually had better results for patients with ulceartive colitis than Crohn's disease. In patients with ulcerative colitis 42% were in clinical remission after one year according to this article. The remission rate for Crohn's patients was only 15%. This is a very low remission rate for Crohn's. What would be interesting to see if the 15% of Crohn's patients had anything in common.