Patients with severe bowel disease could benefit from a new drug that can eliminate their distressing symptoms in just three months.
The once-daily etrasimod tablet treats ulcerative colitis by attaching to the immune cells and preventing them from mistakenly attacking the healthy tissue of the lining of the gut.
In a recent trial, it was found that 27% of patients who had not responded to any other treatment were in remission after only 12 weeks, and 32% had no symptoms after one year.
Ulcerative colitis can be debilitating, causing bloody diarrhea, extreme fatigue, loss of appetite and weight loss.
It can also trigger symptoms such as abdominal pain and digestive upset, similar to the most common problem of irritable bowel syndrome (IBS).
The once-daily tablet of etrasimod treats ulcerative colitis by binding to the immune cells and preventing them from mistakenly attacking the healthy tissue of the lining of the intestine.
Dr Sami Hoque, a Barts Health NHS Trust gastroenterologist in London who led the British arm of the etrasimod trial, described the results as “amazing”.
He added: “When I started treating ulcerative colitis, there were very few options available and what we did caused serious side effects. The advantage of etrasimod is that it is very selective, able to target Rebellious inflammatory cells without affecting the immune system as a whole.
It is a significant addition to existing treatments for bowel disease and, unlike other therapies involving injections, is presented as a once-daily pill. That puts power in the hands of patients, which means they can avoid regular hospital visits. “
Ulcerative colitis is a long-term disorder that occurs when, for reasons that are not fully understood, the immune system goes into excess and attacks the healthy body tissue of the lining of the large intestine or colon, causing inflammation and ulcers. It is one of the two main types of inflammatory bowel disease, along with Crohn’s disease.
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The disease affects approximately 146,000 people in the UK, but experts suggest that many more could be diagnosed and that up to one in ten people over the age of 50 may have some form of the disease.
Patients may go asymptomatic for months before being hit by an outbreak. During these episodes, some patients also experience joint pain, mouth ulcers, and irritated red eyes. In more severe cases, they may also experience shortness of breath, palpitations, and fever.
If doctors suspect colitis, they first take a stool sample to test for a protein called calprotectin, a sign of inflammation in the gut.
If there is a positive result, a gastroenterologist will do more tests to look for physical signs of damage. This usually involves a colonoscopy, where a camera is inserted in the back step and tissue is cut for the test.
The first-line treatment consists of pills or suppositories that contain anti-inflammatory drugs called aminosalicylates. These help control mild outbreaks, but their effect fades over time.
Other options include potent steroids that reduce inflammation, but carry the risk of unpleasant side effects such as acne, mood swings, and diabetes. Drugs that suppress the immune system can also be used, but these can leave patients vulnerable to infections.
If these options fail, as in 15% of cases, bowel surgery may be the only option.
“Etrasimod could be used in combination with existing treatments to strengthen the body’s defenses and prevent the need for surgery,” Dr Hoque said.
The drug is not yet approved. However, experts expect this process to begin by the end of the year.
Romit Zutshi, 42, of Chigwell in Essex, was diagnosed with a bowel disease in 2015 and has been treated with etrasimod as part of Barts’ trial.
A married man’s father first went to his GP after he began to see blood in his stools and had to go to the toilet up to eight times a day.
He said: “Not knowing what was happening to me scared me. I started to lose weight and was constantly tired due to waking up all night to go to the toilet in a hurry.
Because he did not respond to other drugs, he enrolled in the etrasimod trial at Barts in 2020 and noticed “a drastic improvement.”
He added: “I feel safer and I’m able to live more or less like a normal person. Before, I was constantly worried about being near a toilet when I left home and couldn’t exercise well because I would get tired so easily. “But that is no longer a problem.”
STRANGE SCIENCE: Homemade drug that left the man with fungus in his veins
At the hospital, tests showed that the man’s liver and kidneys were failing as the fungus psilocybe cubensis grew in his blood.
A man developed a life-threatening fungal infection after the mushrooms began to grow in the bloodstream.
The 30-year-old American told doctors he had been trying to find a way to treat his mental health problems.
After reading that psilocybin, a hallucinogenic compound found in magic mushrooms, could help cancer patients with anxiety and depression, he boiled them in tea and injected them.
The following days he became nauseous, confused, and began vomiting blood.
At the hospital, tests showed that his liver and kidneys were failing as the fungus psilocybe cubensis grew in his blood.
The man spent 22 days in hospital, eight of them in intensive care, bleeding and two courses of antibiotics, according to The Journal Of The Academy Of Consultation-Liaison Psychiatry.
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