AGA updates Crohn's disease treatment guidelines

[hareyan]

The American Gastroenterological Association (AGA) has release new evidence based guidelines for treating Crohn's disease that are the first to make specific medication recommendations.

The recommendations were formed from a review of risks and benefits, clinical evidence and patient preferences.

"Crohn's disease is a lifelong, relapsing disorder that can damage the bowel and lead to multiple abdominal operations over time. Deciding which medications are the best is a common dilemma for gastroenterologists and the Crohn's patients we treat. The disease can be disabling, but the drugs to control the disease can be toxic too and they can be costly," said Jonathan P. Terdiman, MD, lead author of the guidelines, and Chief of the Gastroenterology Service at the University of California, San Francisco Medical Center. "The new AGA guideline and clinical decision support tool will ease the decision process by providing transparent and actionable recommendations," Terdiman adds.

Biological agents for Crohn's disease remission come first, it says in the updated guidelines for the treatment of Crohn's Disease.

The guidelines are as follows:
Continue reading the 6 guidelines in the original source at:
The American Gastroenterological Association has release new evidence based guidelines for treating Crohn's disease

 

[Clash]

Weird that the article states this:

Examples include Remicade and Enbrel that are perhaps the most popularly prescribed treatment for the inflammatory bowel disease (IBD).

Since Enbrel hasn't shown efficacy in CD:

In fact, in the most authoritative published experience with etanercept in the treatment of inflammatory bowel disease (a randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Crohn's disease), the drug was shown to be ineffective,2

souce

or this:

etanercept does show that although the drug can control the musculoskeletal features associated with the arthritis, and in particular the entheseal pathology that characterises these clinical entities, it is not effective in controlling the bowel symptoms. These findings are in agreement with those of a randomised controlled clinical trial in patients with Crohn’s disease, which show that etanercept is not efficacious in this setting.10

source

good article though.

 

[hareyan]

Thank you Clash, actually it's based on the AGA guidelines for treatment. Emaxhealth doesn't make claims.

 

[Clash]

I agree but just looking over the AGA guidelines from their link:

http://campaigns.gastro.org/algorithms/crohns/index.html

I didn't see any mention of Enbrel or any name brand of anti-tnf.

 

[hareyan]

Oh I see. As it's not quoted, I think it's the opinion of the author just mentioning it as popular prescription for treatment.

 

[kiny]

Remicade and biological equivalents is the only biologic that works for crohn's disease. The only other one that is trying to get to market is vedoluzimab, and it pretty much failed, a drug that gets only 6% in remisson and has to use CDAI scoring to do it is a failed drug.

I don't think the future for crohn's disease drugs is in biologic drugs, how or why remicade works for crohn's disease still isn't known.

 

[hareyan]

Why do you think AGA made these recommendations/guidelines Kiny?

 

[kiny]

I don't know.

Remicade was usually only for severe crohn's disease, not moderate.

Like clash said, etanercept doesn't work for crohn's disease, it reduces TNF-alpha, but it doesn't cause apoptosis of active leukocytes like remicade afaik, I don't think it binds onto TNF-alpha on the cell wall like remicade. Remicade is a special kind of TNF-alpha blocker and the reason it works for crohn's disease is a coincidence, they fully expected etanercept to work too and it didn't.

It's good that they recommend the use of antibiotics too I feel, many people have pointed out they are severely underused. They tend to create resistance, but they are very low on side effects. A regular person might argue that cipro and other quinolones have serious potential side effects (nervous system, ligaments), when you compare them to some other drugs they tried for crohn's disease (vedoluzimab) they are relatively safe drugs.

Quinolones like cipro are also very effective against E coli.

 

[hareyan]

Oh OK, I am about to post a story about natural remedies. Have you tried any, such as Turmeric and Frankincense? Thank you.

 

[kiny]

I've used turmeric a few times. More so because it's a low-toxicity herb and my friend convinced me to try it, I never used it to treat my crohn's disease. I know it affects the immune system and TNF-alpha in some way. But just like etanercept, simply reducing TNF-alpha doesn't seem to work for crohn's disease, so I've used it but didn't rely on it as an actual treatment if that makes sense.