Chrons Disease and Remicade

So what it Remicade?

• First off it is important to note that Remicade is the brand name of the generic medication called infliximab.
• Infliximab (Remicade) is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is one of the proteins produced by immune cells during activation of the immune system. TNF-alpha, in turn, stimulates other cells of the immune system to produce and release other proteins that promote inflammation.
• Remicade is used to treat Crohn's disease, rheumatoid arthritis, as well as other conditions that cause inflammation.
  

How Does Remicade help people with Chrons Disease?

• In Chrons disease, there is continued production of TNF-alpha as part of the immune activation. Remicade (Infliximab) attaches to TNF-alpha and blocks its activity and in so doing decreases the inflammation.
• So Remicade helps put Crohn's into remission by neutralizing TNF-alpha. Remicade is therefore called a TNF "antagonist" that works with your body's immune system to block TNF-alpha, reducing inflammation
• It is now generally agreed that people with chrons who respond well to an initial dose of Remicade will typically continue to improve with more treatments. If a patient does not respond to an initial dosage of Remicade, he or she is unlikely to respond with further treatment.
• The people who respond well to Remicade, the improvements in symptoms can excellent, with rapid healing of the ulcers and the inflammation in the intestines after just one infusion.
• Remicade has also been shown to be effective for treating anal fistulas.
  

How is Remicade (Infliximab) Made?

Infliximab is produced by the immune system of mice. The process involves injecting mice with with human TNF-alpha, the mouse antibody then is modified to make it look more like a human antibody, this is done to decrease the chances of an allergic reactions when it is given to humans. This modified antibody is infliximab.

What are the Side effects of Remicade (Infliximab)?

Remicade suppresses the immune system, generally the medication is well tollerated by the body, but it can have serious side effects and patients must be carefully monitored throughout the treatment.

• Because infliximab is partly a mouse protein, it may induce an immune reaction when given to people with Chrons Diseas, especially with repeated infusions.
• There is also the possibility of a delayed allergic reaction that occurs a week to ten days after receiving the infliximab.
• There have been a few cases of side effects during the infusions, including chest pain, shortness of breath, and nausea.
• Rare cases of nerve inflammation such as inflammation of the nerve of the eye (optic neuritis )

So whilst Remicade represents an exciting new development in the fight against Chrons disease, the long-term safety and effectiveness of infliximab is not yet known.

Chrons Disease and Pregnancy

It was not long ago that women with chrons disease were encouraged against pregnancy, but advances in the knowledge of Chrons disease and it's treatments mean that it is now safer than ever for women with chrons to get pregnant.

Studies have shown that the severity of the Chrons symptoms that are present in the mother at the time conception often continue throughout pregnancy. So if you have Chrons disease and are planning on having a baby the advice is to get the Chron's disease under control and in remission before getting pregnant. This can also give you time to get your body ready for pregnancy as most women even without chrons should do: by increasing the intake of folic acid, quitting smoking, getting more exercise and eating healthier.

Chrons Disease Drugs and Pregnancy
Naturally there are some chrons medications that are best avoided during the pregnancy, but now through research and a history of use, others are considered safe.

What drugs are not safe to take during pregncncy?
Two immunosuppressive drugs that are often used by chrons patients: Methotrexate and thalidomide should not be used during pregnancy. Thalidomide is well known for causing limb defects as well as other major organ complications in an unborn child, whilst the use of Methotrexate should be discontinued at least three months before conception as it has been known to cause abortion and skeletal abnormalities.

What drugs have been deemed safe for use during pregnancy?
So far the research has shown drugs commonly used in the treatment of chrons appear to be safe to take during pregnancy, these include: infliximab (Remicade), azathioprine (Imuran, Azasan), adalimumab (Humira) and certolizumab (Cimzia)

A few other drugs that are often used in Chrons disease flare-ups are also safe for pregnant women to use, these include: sulfasalazine (Azulfidine), forms of mesalamine (Asacol, Pentasa, Rowasa) and corticosteroids (Prednisone).

The best advice is to work very closely with your doctor that you are seeing for Crohn's disease as well as your obstetrician and your baby's pediatrician and don't be afraid to ask questions. As it is important point to remember that the biggest factor influencing a healthy pregnancy is the state of the chrons disease activity, so a well planned pregnancy when your chrons is in remission has the greatest chance for the best outcome.

Inflammatory bowel disease should be controlled prior to pregnancy: ulcerative colitis, Crohn's disease. (Women's Health).: An article from: Family Practice News

Can Digestive Advantage help Chrons & Colitis?

Today I read about an over the counter drug that has been approved by the Food and Drug Administration (FDA), that is supposed to help people with conditions including Irritable Bowel Syndrome, Chrons disease and colitis.

The drug known as Digestive Advantage™ Crohn's & Colitis Therapy mostly contains a patented probiotic called GanedenBC30 that is said to help the functioning of the digestive system. The specially isolated cultures are protected by a hardened layer of organic material that enables them to go through your acidic stomach environment and successfully arrive to your intestines, which is where they can have the most benefit.

I wonder how well these are going to help people with chrons disease, what I do know is that it won't be a miracle cure as the do say in the small print that "Digestive Advantage™ Crohn’s & Colitis Therapy is a Medical Food product that is intended for use by Crohn’s & colitis sufferers who are under the supervision of a physician. It is not a cure for Chrons or ulcerative colitis nor is it intended to replace any medications that were prescribed by a physician"

What ever the case, at the moment I think that it is only available in the US at a cost of about 55c per day, it could be worth speaking to your doctor about.

If anyone has tried them or knows any thing more I would love to get your feedback.

You can find more information on their website: Digestive Advantage™ Crohn’s & Colitis

Chrons Disease With Fistulas Breakthrough

There is real hope for people who have fistulas because of their Chrons Disease as it was recently announced in France at the European Chrons and Colitis Organization (ECCO) annual meeting that HUMIRA (Adalimumab) is successful for the treatment of fistulas in people who have Crohn's disease.

So what is Chrons disease?

Chrons Disease is basically a gastrointestinal disorder where there is chronic inflammation of the walls of some part of the digestive tract. People affected with the disease suffer periods of flare-ups and then periods where they are in remission, this can continue through the whole life of the person.

Is Chrons Disease the same as ulcerative colitis?
The short answer is No, Chrons is considered medically as an inflammatory bowel disease (IBD) and it is similar to ulcerative colitis.

Fistulas and Chrons
In a recent study, it was suggested that almost half (43%) of Chrons disease patients will develop fistulas, which can be both painful and embarrassing.

What Are Fistulas?
Fistulas are basically tunnels that connect the chrons affected organs to surrounding tissues. These can include the bladder, vagina, or even the skin. Fistulas are very difficult to treat and can cause fecal discharge from abnormal locations, leading to not only embarrassment but also incontinence, infections, and other complications that will usually mean that the patient has to undergo surgery.

So how can HUMIRA (Adalimumab) help?
HUMIRA, or Adalimumab works by binding Tumor Necrosis Factor α (TNF-α), which is an important part of the immune response pathway

Because of this, Adalimumab is related to infliximab and other similar TNF-α blockers. The good news is that it has already been given the green light in a few countries for treatment of many diseases that are autoimmune related including Chrons Disease, psoriasis and some types of arthritis.

The study that took place showed some very posetive results and did point to the fact that the healing of fistulas was a lot better in people who had been given HUMIRA:

• 60% of chrons patients showed fistula healing after 1 year of treatment
• 76% of patients who showed the improvement and healing after 1 year continued the healing up to 2 years
• 71% of patients showed a significant 50% reduction in the number of draining fistulas after 2 years of treatmen with HUMIRA.
  

During thsese 2 years that people with chrons with fistulas had a higher quality of life because the disease was in remission.

All sounds like excellent news, I would love to hear from anyone who has any first hand exprience, if you have please leave a comment.

Chrons Disease and Aggressive Therapy

A recent study has shown that if you treat chrons disease more aggressively, it resulted in a better outcome for patients. This study was performed by an international team of researchers.

The researcher's found that shortly after a person had been diagnosed with chrons disease, using more than 1 immunosuppressive drug was more effective in inducing remission than starting patients on corticosteroids.

One of the researcher's, Dr. Brian Feagan said that more studies needed to be conducted, but if you treat chrons patients earlier with more aggressive therapy it may be more effective than the traditional method. Doctors are always looking for ways to treat people who suffer from chrons disease without the use of steroids, so this could mean en exciting development.
Nobody really knows the true cause of chrons disease but basically what happens is there is an inflammation of the gut that often affects the small intestine, the swelling leads to pain and diarrhea. The current theory is that someone with crohn's disease has lost tolerance to normal bacteria in the gastrointestinal tract. "The immune system is in a controlled inflammatory state. In Crohns disease, it is thought that the immune system is becoming unhappy with normal flora. White blood cells migrate into the tissue and release nasty things and cause damage." said Feagan, director of Robarts Clinical Trials at Robarts Research Institute at The University of Western Ontario in London, Ontario, Canada.

The current usual treatment for someone with crohns begins with corticosteroids. If the patient shows really bad side effects to the steroid treatment or if some sort of resistance to the drug begins to show the treatment usually moves on to a range of immunosuppressive drugs like Rheumatrex (methotrexate). If this treatment does not help, tumor necrosis factor (TNF)-blockers are often then used.

Remicade (infliximab) with Imuran (azathioprine)
In the research 133 people with chrons disease in Belgium, Germany and Holland had either combined immunosuppression or the traditional method. 67 had the joint immunosuppression with three infusions of Remicade (infliximab) with Imuran (azathioprine) at the start and then again a few weeks later and then again 4 weeks after that. The other 66 patients were given steroids ad then given Imuran and Remicade.

Study Results
Some initial findings show that after 6 months sixty percent of the patients on the combined immunosuppression had their chrons disease in remission with no need for steroids or any form of surgery. From the second group only 35.9% were in remission.

Later on, after one year the figures were:
61.5% of the combined immunosuppression group were in remission compared to ony 42.2 % of patients following the more traditional method of chrons disease treatments.

More research is to follow, but if they come to the same conclusion, the conventional treatment for Chrons could change.

Down sides to Remicade (infliximab)
Remicade is administered intravenously so the person has to go to a medical center to receive treatment.

Chrons Disease Drug Tysabri has been approved

There is some great news for people who suffer from Chrons Disease in the US as the Food and Drug Administration has approved the use of a drug called Tysabri (natalizumab).

Tysabri which is produced by Ireland based company Elan and Biogen Idec in the USA is to be used on chrons patients who have not responded to other forms of treatment, it was given the green light in 2006 to treat people who have elapsing multiple sclerosis and will now be given the all clear to be used with people suffering from Chrons Disese.

Possible side effects of the drug include the risk of progressive multifocal leukoencephalopathy which is a viral infection that affects the brain. This viral infection could cause severe disability or even death. Another possible side effect are anaphylactic reactions and possible liver injury.

Because of these possible serious side effects people with chrons disease who are prescribed the drug Tysabri will also be added to a restricted distribution program called Crohn's Disease-Tysabri Outreach Unified Commitment to Health (CD-TOUCH).

This program will allow doctors to check the chrons disease patients that are using Tysabri after three months and will be asked to stop using the drug if there if there are no signs of improvement in that time.

Drug Details
Drug Name: TYSABRI (Brand Name Drug)
FDA Application No. (BLA) 125104
Active Ingredient: NATALIZUMAB
Company: BIOGEN IDEC
Original Approval or Tentative Approval Date: November 23, 2004
There are no Therapeutic Equivalents

Chrons Disease is an incurable disease that affects the bowel. Symptoms often include diarrhea, fever, rectal bleeding, malnutrition, narrowing of the intestines, cramping, and abdominal pain. Chrons disease affects more than one million people around the world and can also lead to abnormal connections that are called fistulas from the intestines to the skin or internal organs.