Revolutionary Breakthrough! Research Elevates Crohn’s Disease Treatments to Unprecedented Heights

By Randy Longman, MD, as told to Marijke Vroomen Durning, RN

I have been working with patients with inflammatory bowel disease (IBD), which includes Crohn’s disease, for approximately 15 years. Treating patients with chronic conditions like Crohn’s disease can be challenging, but it is also very rewarding. As their doctor, I have a unique opportunity to develop long-term relationships with them. I am there during difficult times to provide medical assistance, care and support.

It is also an exciting time to be in the field of Crohn’s disease treatment because of the ongoing research and new treatment options that can change the lives of my patients. With so much going on, I don’t want my patients to lose hope because we don’t know what’s around the corner. There are so many more drugs and therapy combinations that sometimes the next drug may be right for them.

Improved diagnosis and treatment over the years

Treatment for Crohn’s disease has changed significantly since I started practicing. At first, we only had oral medications, such as steroids or corticosteroids, to offer our patients. These drugs can certainly be helpful in some situations. They reduce inflammation in the gut, especially during exacerbations or flare-ups. But these drugs can also have serious side effects. For example, long-term steroid treatment can cause cataracts and weaker bones, and can put patients at greater risk of infection. So we don’t want patients taking these drugs too often or for long periods of time.

Immunomodulatory drugs were our other option. They are also good medicines and help many patients. The most common ones used to treat Crohn’s disease include:

• Azathioprine (Azasan, Imuran)
• Mercaptopurine (Purinethol, Purixan)
• Methotrexate (Trexall)

These drugs reduce inflammation by changing the way your immune system reacts, decreasing symptoms. But they can also have serious side effects, such as nausea, fever, and fatigue, so some people can’t take them.

But now, there is even more hope. Thanks to research and development, the treatment of Crohn’s disease has gone beyond steroids and immunomodulatory drugs. Now, we have biologic therapies to offer our Crohn’s disease patients. These are drugs that target specific inflammatory molecules in the body. In my opinion, they have transformed the natural history of this disease.

In 1998, the FDA approved infliximab, a drug that targets TNF alpha, to treat Crohn’s disease. In the last 10 to 15 years, we’ve had a lot of other drugs that target TNF alpha, as well as other drugs that target certain enzymes and their pathways. These new drugs provide new options for patients who have not been successful with traditional treatments.

But treatments for Crohn’s disease don’t end there.

Historically, we treated patients with Crohn’s disease by taking one treatment at a time, adjusting or changing the medication if they did not respond well. But we have learned a lot about combining drugs to make them work best. This gives us yet another approach to help our patients.

The tests have also improved. Now we can find out how well a patient responds to treatment, not only for symptom relief, but now we can do blood tests for therapeutic drug monitoring (TDM). Measuring drug levels in the blood allows us to actively monitor the evolution of our patients, making the most of their care.

We have also devised new diagnostic technologies, including genetic and molecular blood markers. These markers tell us the type of intestinal inflammation and the subtypes of Crohn’s disease that the patient has. This knowledge helps us design personalized therapies for patients.

Recognition will come sooner

The sooner patients with Crohn’s disease are treated, the better, and earlier recognition and diagnosis play an important role in this. Organizations like the Crohn’s and Colitis Foundation and others have done great work to raise awareness about IBD, including Crohn’s disease. Her outreach encourages people to talk about symptoms, even if they are embarrassing or difficult to treat. Allowing and encouraging people to talk about symptoms like abdominal pain, diarrhea, or even rectal bleeding means they can be diagnosed sooner if they have IBD.

A team approach improves Crohn’s care

Other contributions to the general approach to Crohn’s disease health care have also made a difference in the effectiveness of therapy.

Obviously, the main focus should be to identify the correct medications to help control the intestinal or systemic inflammation of Crohn’s disease. But even once the inflammation is controlled, there can still be uncomfortable intestinal symptoms like gas, bloating, and diarrhea.

Malnutrition in Crohn’s disease is also a real problem. Due to inflammation of the intestine, nutrients are not easily absorbed, especially vitamins. Children with Crohn’s disease may also have delayed growth.

One of the ways we approach this at our center is to have an IBD specialist dietitian. Having dietitians who are aware of the nutritional issues that accompany IBD can make a world of difference in a patient’s well-being.

Health professionals to address the psychosocial issues related to living with Crohn’s disease are also essential. These problems can affect anyone at any age, but some groups may be at higher risk. The symptoms of Crohn’s disease often begin in late adolescence and early adulthood. This can be a very stressful time for most teens in high school or college adjusting to life with a chronic illness, so being sensitive and supportive is critical. In our practice, and in many IBD centers, a social worker is frequently on the team. As a result, they are able to detect challenges our patients may have and provide resources and support.

It’s also important to recognize that even for adults, this can be a very stressful illness. There are not only medical problems, but also social and professional ones, and the treatments carry a financial burden. So even if you have insurance, and even good insurance, there are always significant medical and financial issues if you have a chronic illness.

Looking to the future

I believe there are still a number of unmet needs when working with people with Crohn’s disease. First, much research seeks to identify the disease earlier, especially among people with a family history. Another important focal point is knowing which drug to select for which patient, based on the algorithms, how severe the disease is at the moment, and other things like drug side effects.

We should also look for areas of active research on complications related to Crohn’s disease. For example, it can cause a fistula, an abnormal opening in the colon, and this can be very aggressive. Crohn’s disease can also cause fibrosis, thickening, and scarring of tissue in the colon, which can lead to a stricture or obstruction. This major complication of Crohn’s disease can lead to the need for surgery.

We do not yet officially have drugs that directly target fibrosis or stricture. But I do anticipate that in the next 5 to 10 years, we will have drugs to specifically address this and reduce the burden of stenosis that comes with Crohn’s disease.