TNF Alpha Inhibitors vs. Biologic Therapies

Crohn’s Disease patients can often go through a variety of treatments and still be frustrated that symptoms persist.

For patients who have tried steroids, antibiotics, and other treatments with no signs of remission or relief, tumor necrosis factor, or TNF blockers can be an effective, but risky, solution.

For patients seeking biological therapies for Crohn’s, however, TNF blockers aren’t the only option. Another aggressive therapy, natalizumab, works to interfere with the process of white blood cells attaching to the lining of the intestines, which results in reduced inflammation and relief from other symptoms. Some severe, even fatal, side effects have been associated with natalizumab, and its benefits in battling Crohn’s disease should be weighed against the side effects and benefits of TNF inhibitors in making treatment decisions.

What are Biological Therapies?

Biological therapy refers to any therapy that works to block the immune system’s natural response to antigens. In Crohn’s patients, the body’s immune system can’t tell the difference between foreign substances and the body’s own tissue, which is the cause of the inflammation that creates so many symptoms in Crohn’s patients.

TNF blockers block this immune response from happening but, as you can imagine, this can create new problems for Crohn’s patients, since TNF blockers can’t solely block the immune system from attacking the body’s own tissue while leaving the natural immune responses intact. This leaves the Crohn’s patient susceptible to other diseases and infections and, in some cases, increases the patient’s risk for certain cancers.

Unlike other forms of therapy, which are generally attempted first, biologic therapies and TNF alpha inhibitors work by aggressively targeting particular proteins that cause inflammation in the patient’s gastrointestinal tract. Because of this, they tend to have success when other treatments have failed. However, the result of this aggressive therapy is that other parts of a patient’s health may be compromised.

The Cost of TNF Alpha Inhibitors

TNF alpha inhibitors are not only risky, but expensive as well. Treatments ?can sometimes cost up to thousands of dollars, with some medications requiring patients to spend hours in the doctor’s office receiving treatment intravenously. This is not only financially detrimental, but time-consuming for patients who are required to take large amounts of time from their workday for treatment.

Patients on TNF blockers can experience an increased risk of tuberculosis as well, with some physicians believing tuberculosis and other infections are not only likely, but even expected. So in addition to injections or IV treatments, patients will also need to schedule appointments for regular skin tests to detect the presence of infection in the body.

Some Crohn’s patients are able to take a TNF blocker treatment that can be administered at home. These patients are given pre-filled pens or syringes with just the right amount of medicine. They are given a dosage schedule and allowed to administer treatment themselves.

TNF blockers are sold under the brand names Remicade, Humira, and Cimzia.

Natalizumab? (Tysabri)

A treatment is available that doesn’t block TNF but provides effective biologic therapy like TNF blockers. Natalizumab works by preventing integrens from binding to other cells in the patient’s intestinal lining.

Often prescribed for patients with multiple sclerosis, natalizumab is sold under the brand name Tysabri and was approved for the treatment of Crohn’s disease in 2008.

Manufacturer Elan Corporation tested Tysabri and over the course of three months, with sixty percent of Crohn’s patients responding well to therapy. However, forty-four percent of patients taking a placebo in the study responded well. One year after the testing, fifty-four percent of patients were still showing improvement, compared to only twenty percent that took the placebo.

Before being able to take Tysabri, however, patients must be enrolled in a program called CD Touch (Crohn’s Disease Tysabri® Outreach Unified Commitment to Health). This is due to the extreme risk of a rare but deadly brain disorder that has been connected with Tysabri. The disorder, called progressive multifocal leukoencephalopathy (PML), is an inflammation of the white matter of the brain, usually at more than one location.

According to Reuters, PML is now found to affect 1.16 in every 1,000 patients, with twenty deaths having been reported as of February 2011. Because treatment has been going on for several years, more cases are expected, experts say, and even more cases are likely to emerge as more is learned about the long-term effects of Tysabri.

Physicians will likely resort to all biologic therapies after other forms of medication are ruled out. While biologic therapies are found to be effective in more severe cases, patients should be aware of their risks and weigh them before using them as treatment.