Therapeutic Focus

Inflammatory Bowel Diseases (IBD) are a group of chronic, progressive, recurring and debilitating disorders characterized by severe damage of the gastro-intestinal tract. The main forms of IBD are Ulcerative Colitis and Crohn’s Disease. Both diseases are clinically similar and may be described as a faulty regulation of the mucosal immune response.

The causes of Inflammatory Bowel Disease are not known but it is widely believed that they could be ascribed to an auto-immune mechanism.

Inflammatory Bowel Disease currently affects approximately 0.5% of the Western world’s population. According to the U.S. Crohn’s and Colitis Foundation, the Ulcerative Colitis and Crohn’s Disease U.S. population size is estimated to be in excess of 1.4 million patients.

The Treatment of Inflammatory Bowel Disease

At present there is no cure for Inflammatory Bowel Disease. The goal of medical treatment therefore is to suppress the inflammatory response so that the intestinal tissue may heal and the patient is relieved from symptoms, such as bleeding, diarrhoea and abdominal pain. For patients who suffer from intermittent forms the goal of medical therapy is, furthermore, to decrease the frequency of disease recurrences by the administration of maintenance medications to prevent a relapse of the disease. However, the groups of pharmaceutical products currently used are accompanied by unwanted negative effects and may not attain the best possible therapeutic results.

The following groups of pharmaceutical products are currently used to treat Inflammatory Bowel Disease:

• Aminosalicylates (5-ASA):
  This class of anti-inflammatory pharmaceutical products is typically used to treat mild to moderate forms of Inflammatory Bowel Disease.
• Corticosteroids:
  Corticosteroids are used to treat moderate to severely active cases of Inflammatory Bowel Disease that do not respond to treatment with Aminosalicylates. These pharmaceutical products have significant side effects which make their long-term use problematic.
• Immunosuppressive Pharmaceutical Products:
  Immunosuppressive pharmaceutical products inhibit the general immune system by inhibiting cell division including the cloning of white blood cells that is part of the immune response. They are used to treat severe cases and may help to decrease corticosteroid dosage and to heal fistulas. Also, these products may lead to side effects if they are used for a prolonged time and in high dosages, as they negatively affect the whole immune response of the patient.
• TNF Alpha Inhibitors:
  TNF alpha is a protein that is released by activated white blood cells, triggering more inflammation, an immune system response and more damage to the mucosa of the colon. Certain pharmaceutical products inhibit TNF alpha, hence reducing inflammation and immune system involvement. TNF alpha inhibitors are usually given as an intravenous infusion. They are very useful for inducing and maintaining a remission of Crohn's Disease and Ulcerative Colitis. TNF alpha inhibitors have important side effects which can make their long term use problematic.