The Journal of Crohn’s and Colitis has published a study that could lead to a new way of prescribing biologics to those suffering from IBD. Researchers have found two particular strains, one fungal the other bacterial, in the intestines of IBD patients that failed to respond to Infliximab (Remicade). Infliximab is almost always the first biologic of choice for IBD patients. If there was a way to know if someone will fail to respond, it could mean less time suffering for the patient, as they could move on to the next option without wasting weeks to see if it works. This discovery is another major breakthrough in understanding IBD as well as biologics’ effect on them.
Currently, if an IBD patient isn’t having success with their current treatment, there is a tiering of medications to go through and they are simply bumped to the next tier. Standard treatments usually start with 5-ASA’s, followed by a variety of corticosteroids, then immunomodulators/ suppressors, and finally biologics. As you can imagine, by the time you start trying out biologics, you’re tired of the ‘let’s try this one’ monologue. With infliximab as the first line of defense in the world of biologics, knowing if the patient will respond or not is huge! Believe it or not almost a third of IBD patients don’t respond to Infliximab. Having this insight will improve the lives of those experiencing symptoms, by finding the right medication quicker.
The study included 72 IBD patients. 25 had Crohn’s and 47 had Ulcerative Colitis. These patients were followed for one year after starting Infliximab. The subjects submitted fecal samples to be examined at 2, 6, and 12 weeks. These samples provided microbial profiles. After the 12 weeks, a colonoscopy was done to evaluate inflammation and active disease. They found that both bacterial and fungal profiles were very different before and after taking the treatment. Most importantly, they found that non-responders to Infliximab had lower amounts of short chain fatty acid producers, specifically Clostridia, compared to those who responded well. These non-responders also had much higher levels of proinflammatory fungi and bacteria like Candida. This microbial composition correlated to lack of response to Infliximab in both UC and CD patients.
This incredible find could soon change how infliximab is prescribed. Using this knowledge, a test kit could be made, given in the office, and sent off to the lab to get results. This would lead to knowing in days instead of months if this biologic will work for the patient. This would be an easily implemented predictive tool to give an educated estimate to IBD patient response. The more we understand about IBD, the more patient care and treatments can advance.
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