In good news for patients with stubborn cases of ulcerative colitis, a serious intestinal disorder, a new research review suggests that the drug infliximab can be a useful alternative if other treatments don't work.
The drug is currently used to treat rheumatoid arthritis and Crohn's disease.
"For people with active ulcerative colitis who do not respond to corticosteroids or immunosuppressive agents, infliximab is effective in inducing clinical remission, inducing clinical response, promoting mucosal healing and reducing the need for colectomy, at least in the short term," said review co-author Dr. Anthony Kwaku Akobeng.
Akobeng, a gastroenterologist at Manchester Children's University Hospitals in England, and colleagues examined seven randomized controlled studies comprising 860 patients that evaluated infliximab as a treatment for ulcerative colitis.
The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
"Infliximab is another option if steroids fail," said Peter Higgins, M.D., an assistant professor in gastroenterology at the University of Michigan Medical Center in Ann Arbor.
Still, infliximab "has known infectious risks, which while rare, can be fatal," said Higgins, who was not involved with the review. He added that it's not clear if it's a better option than cyclosporine, another drug commonly used when other medications fail.
The disease afflicts an estimated 600,000 Americans, and occurs when ulcers form in the rectum and colon, leading to frequent diarrhea and bleeding.
According to Higgins, the causes of ulcerative colitis aren't clear, but they may have something to do with an interaction between a person's genetic makeup and another factor, such as infection or the use of non-steroidal anti-inflammatory drugs, a class of painkillers that includes ibuprofen (Advil) and naproxen (Aleve).
The interactions may cause "an abnormal interaction between bacteria in the gut and the immune system," Higgins said.
Meanwhile, "mechanisms that lead to a reduction of inflammation in response to bacterial products are defective, so the body has a hard time 'resetting' itself, and the inflammation becomes chronic," said Gerald Dryden, Jr., M.D., an associate professor at the University of Louisville in Kentucky.
There are a number of drug treatments for colitis, including steroids, which reduce inflammation by dampening the body's immune system, and aminosalicylates, which also help control inflammation.
In some cases, however, the colon must be removed; some patients must use colostomy bags for the rest of their lives.
In recent years, researchers have begun looking at infliximab -- also known by the brand name Remicade -- as a possible treatment for moderate and severe colitis.
In the review studies, patients were given either infliximab or a placebo for moderate and severe cases of ulcerative colitis. All the patients failed treatment with steroids and/or other drugs that suppress the immune system.