Only a few medications were available for medical management in patients with IBD prior to 1990: corticosteroids, sulfasalazine, metronidazole, azathioprine, and 6-mercaptopurine (6-MP). Since then, there has been a dramatic increase, both in research and the number of the treatment options. Medical therapy for IBD has three main goals: inducing remission (controlling flare-ups of the disease), maintaining remission (preventing flare-ups), and improving the patient's quality of life. To achieve these goals, therapy must suppress the chronic inflammation in the intestine which causes the signs and symptoms of IBD patients.
When this inflammation is under control, patients can get the nutrients they need, and avoid surgery and complications of IBD. However, there is no single ideal therapy for IBD and treatments must be tailored to each person's need. Because there is no cure for Crohn's disease, the goal of medical management is suppress the inflammatory response and manage of its symptoms.
The advent of the era of biologic therapy in 1998 with the introduction of infliximab (Remicade) allowed us to begin focusing on the therapeutic management of patients with Crohn's disease. Novel biologic agents have targeted and block tumor necrosis factor (TNF) which is a naturally occurring chemical involved in inflammatory and immune responses. In patients with active Crohn's disease, there is an increased production of TNF in intestinal lining, and increased excretion of the TNF in their stools.
Two-thirds of patients with Crohn's disease improved and one-third achieved with infliximab infusions. Infliximab infusions were also effective in closing most fistulas in patients with Crohn's disease. Additional trials demonstrated that long-term maintenance therapy with infliximab is necessary for a majority of patients rather than intermittent "as needed" schedule of therapy. However, up to 30% of patients do not respond to this agent and another 20-30% may have an incomplete response. Moreover, up to 60% of patients with Crohn's disease have developed antibodies against infliximab that may lead to hypersensitivity reactions and probably result in diminished clinical response to infliximab therapy over time.
Dr. Ertan and others' research with new biologic therapies are emerging to treat refractory cases with Crohn's disease. This is an exciting time for gastroenterologists who treat patients with Crohn's disease, as suboptimal traditional therapy is placed with biologic agents that target more specific mechanisms and are more effective. Dr. Ertan is a principal investigator in several research protocols with different novel biologic agents which are not commercially available for the management of refractory IBD patients.
You may call Inci Ertan, PhD or Patricia Bellinger, NP at 713-794-0001 for further detailed information regarding these active research protocols.