Upping the Dose in Crohn's Treatments

Crohns therapies lose effectiveness among patients who are not free of symptoms immediately

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Easing the discomfort with Crohn's disease remains a difficult task. Though the troubles could be swayed with two medicines, the effects are temporary.

Patients who do not get better immediately after starting treatment will likely need to up their dosage every so often, a recently published study has found.

"The major finding of this study is the loss of response occurred in more than one third of Crohn's disease patients who showed response or achieved remission after … induction therapy," the authors wrote in their report.

The researchers found stomach aches go away in 70 percent of people who first take the medicine.

"Medicines work - if you take them."

Crohn’s disease, the most common inflammatory bowel diseases, causes pain along the digestive tract and could lead to malnutrition.

Researchers led by Tamás Molnár, professor in the First Department of Medicine at the University of Szeged in Hungary, aimed to see at what point patients with Crohn's would stop responding to set dosages of two different drugs when taken for a year.

The drugs, infliximab and adalmumab, treat long-term inflammatory diseases and blocks the cells that cause inflammation.

The study included 61 Crohn's disease patients who managed most of their stomach troubles after the first therapy.

On average, patients were 26-years-old and had the disease almost seven years. In the study, they were treated at a clinic and continued to receive therapy regularly.

Patients given the infliximab, known commonly as Remicade, had a follow-up appointment every four weeks in the first 12 weeks after their first treatment, then every eight weeks after that.

Those who had adalmumab, known as Humira, were followed up every couple of weeks the first eight weeks after the first therapy.

Follow-up appointments then occurred once a month for two months and every two months after.

Researchers focused on whether the dosage needed to be increased during the course of the one-year treatment.

They also looked for patients who

  • needed to switch therapies because of an allergic reaction
  • needed surgery on top of their treatment, and
  • couldn't be weaned off their medicine

They found more than 70 percent of the participants were symptom-free after first taking the medication, with symptoms improving in the rest of the patients.

Treatments stopped working in more than a third of Crohn's patients after a year of therapy.

The percentage of people who stopped having Crohn's symptoms was significantly lower in those who stopped responding to treatment, compared to those in which the treatments continued to work.

Those who continued to be free of their symptoms received therapy to maintain their immune system before and while taking the medications.

Of the 86 percent of participants who needed the dose to be increased or to shorten the time between taking their medication, almost 37 percent of patients were symptom-free again.

Another 26.3 percent of participants had fewer stomach problems. The authors did not report whether any side effects occurred with the increase in dose amount.

And the treatment stopped working more frequently and earlier among those who had adalimumab versus the influximab.

"Loss of response develops despite using maintenance therapy and the flare-up cannot be controlled with the regular infusion," the authors wrote in their report, "therefore dose increase or decrease in the intervals is required."

More than 60 percent of patients felt better or returned to remission after therapy was increased. And most patients who took the medicine did feel better versus those who did not take them at all.

The Hungarian Scientific Research Fund supported the study. The authors don't declare any conflicts of interest.

The study was published online June 26 in the Journal of Gastrointestinal and Liver Diseases

Reviewed by: 
Review Date: 
October 24, 2012
Last Updated:
October 29, 2012