Understanding Why Biologics Fall Short in Crohn’s Disease Treatment

In his book “The Prevention and Treatment of Crohn’s Disease, Dr. Gilles R. G. Monif discusses why efficacy with biologics is limited.

Biologics, like adalimumab, initially gave hope to Crohn’s patients. In its FDA filing, adalimumab produced short-term remissions in 40% of treated individuals, which was encouraging.

Despite the initial optimism, biologics’ ability to reduce inflammation has been palliative rather than curative.  Despite nearly 20 years of use, biologics have not been able to induce long-term Crohn’s disease remissions. Therapy with biologics does not preclude the development of Crohn’s disease’s most severe sequela, such as fistulae, strictures, loop-to-loop anastomoses, bowel perforation, abscess formation, and sepsis when focal submucosal infection of the gastrointestinal tract is left undertreated.  

For Crohn’s disease, just immune system suppression is insufficient. When clinical results achieved with biologics are contrasted with those achieved with dietary manipulations, the outcome differences speak for themselves. Vegetarian-like diets that emphasize plant-based foods and limit dairy and meat, have long shown promise. Sigall-Bonehet et al. achieved clinical remissions in 70% of individuals with CD using exclusion diets. Chiba et al. reported that 94% of Crohn’s afflicted individuals who remained on a semi-vegetarian diet maintained their clinical remission whereas 33% who returned to a regular diet relapsed. These results were achieved in the absence of an understanding as to WHY and at a fraction of the cost of therapy with biologics.

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