Crohn’s Disease and Biologicals

Anjali (name changed), a 38 year old bank executive, who had been troubled by recurrent bouts of loose stools over a year and had lost 4 kg weight,and for which she had been prescribed several courses of antibiotics, without lasting relief, had begun to get a “gut feeling” that something was not quite right. She had also started experiencing severe backaches and stiffness of the joints that was interfering with her work.

Exhausted, and at her wit’s end, she underwent a colonoscopy, by which we inspected her large intestine, and discovered that she had patchy ulcers and swellings. The biopsy report indicated Crohn’s Disease.

Crohn’s Disease(CD) is an auto-immune disease, in which the defence forces of the body misguidedly attack its own parts, the intestines in this case. Immune cells called lymphocytes pile up in the intestinal walls and pour out cytokines that imprudently attack and destroy the intestinal cells instead of invading germs. Once considered rare, CD is being increasingly diagnosed in India almost as commonly as in the west.

We were then confronted with choosing the best treatment. The common therapy prescribed on such occasions is cortico-steroids,which suppress the inflammation. They however have a long list of side effects: proneness to infections and diabetes, increase in blood pressure, brittleness of bones, and most importantly for a good-looking young lady like Anjali, development of moon-like swelling of the face.

An alternative was to use a relatively new but expensive group of drugs called “biologicals”, which selectively block the immune-attack occurring in the walls of the intestines. As the main ammunition in CD and Rheumatoid arthritis comes in the form of Tumor Necrosis factor-alpha (TNF-a), scientists have been able to produce blocking anti-bodies that can neutralize them, thus effecting a temporary cure. The medicine, called infliximab, comes as a liquid and has to be given as periodic intravenous infusions.

After detailed consultations with her husband and several specialist doctors, Anjali opted for Infliximab therapy consisting of 3 induction doses within 2 months. She fortunately had enough insurance to cover the cost of Rs 75,000/- for each infusion.

Within a week of the very 1st dose she took in April, she felt 90% well, much better than she had ever felt in the last one year. Her stools returned from 6-10 loose ones a day to a singlewell-formed one. Her back ache, another manifestation of CD, disappeared as she gained 6 kg of weight and began bubbling with energy and strength once again.

Biologicals, while often working as miracle drugs, have their share of problems too. Being proteins in nature, they often instigate the body to develop anti-bodies to them, which neutralize and reduce their effect with time.

Despite this major advance in medical science, the main hurdle remains their exorbitant cost that keeps them beyond the reach of most Indians. We hope Indian firms will be able to produce them in good quality at affordable prices.

As published in HT City ( Hindustan Times) dated 4 August, 2013.