Patients with severe bowel disease could benefit from a new drug that can eliminate their distressing symptoms within just three months.
Once-a-day tablet etrasimod treats the condition ulcerative colitis by binding to immune cells and preventing them from mistakenly attacking healthy tissue in the lining of the gut.
In a recent trial, 27 per cent of sufferers who had failed to respond to any other treatment were found to be in remission after just 12 weeks, and 32 per cent were symptom-free after a year.
Ulcerative colitis can be debilitating, causing bloody diarrhoea, extreme fatigue, loss of appetite and weight loss.
It can also trigger symptoms such an abdominal pain and digestive discomfort – similar to the more common problem irritable bowel syndrome (IBS).
Once-a-day tablet etrasimod treats the condition ulcerative colitis by binding to immune cells and preventing them from mistakenly attacking healthy tissue in the lining of the gut
Dr Sami Hoque, a gastroenterologist at Barts Health NHS Trust in London who ran the UK arm of the etrasimod trial, described its results as ‘astonishing’.
He added: ‘When I started treating ulcerative colitis, there were very few options available, and what we did have caused severe side effects. The advantage of etrasimod is that it is very selective, able to target unruly inflammatory cells without affecting the immune system as a whole.
It’s a significant addition to existing treatments for bowel disease and, unlike other therapies which involve injections, it comes as a once-daily tablet. This puts the power in the hands of patients, meaning they can avoid regular visits to hospital.’
Ulcerative colitis is a long-term disorder that occurs when, for reasons not fully understood, the immune system goes into overdrive and attacks healthy body tissue in the lining of the large bowel or colon, causing inflammation and ulcers. It is one of two major types of inflammatory bowel disease, alongside Crohn’s disease.
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The condition affects roughly 146,000 people in the UK, but experts suggest many more could be undiagnosed and that as many as one in ten over-50s may have some form of the disease.
Patients can go for months without symptoms before being struck by a flare-up. During these episodes, some patients also experience sore joints, mouth ulcers and irritated red eyes. In the most severe cases, they may also suffer shortness of breath, palpitations and a 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 conduct further tests to look for physical signs of damage. This usually involves a colonoscopy, where a camera is inserted into the back passage and tissue is cut out for testing.
First-line treatment involves tablets or suppositories containing anti-inflammatory drugs called aminosalicylates. These help to manage mild flare-ups, but their effect wears off over time.
Other options include powerful steroids that lower inflammation but come with 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 per cent of cases, surgery to remove the bowel may be the only option.
Dr Hoque said: ‘Etrasimod could be used in combination with existing treatments to reinforce the body’s defences and stave off the need for surgery.’
The drug isn’t yet approved. However, experts hope that process will begin later this year.
Romit Zutshi, 42, from Chigwell in Essex, was diagnosed with bowel disease in 2015 and has been treated with etrasimod as part of the Barts trial.
The married father-of-one first went to his GP after he began to see blood in his stool and needed to go to the toilet up to eight times a day.
He said: ‘Not knowing what was wrong with me was scary. I began to lose weight and was constantly tired due to waking up through the night to rush to the toilet.’
Having failed to respond to other drugs he was enrolled on the etrasimod trial at Barts in 2020 and noticed ‘a drastic improvement’.
He added: ‘I feel more confident and am able to live more or less like a normal person. Previously, I would be constantly worried about being near a toilet when I left the house and couldn’t exercise properly because I would tire so easily, but that’s not a problem any more.’
WEIRD SCIENCE: Home-made drug that left man with fungus in his veins
At hospital, tests showed the man’s liver and kidneys were failing as the fungus psilocybe cubensis was growing in his blood
A man developed a life-threatening fungal infection after mushrooms began growing in his 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 into a tea and injected it.
In the following days he became nauseous, confused and began vomiting blood.
At hospital, tests showed his liver and kidneys were failing as the fungus psilocybe cubensis was growing in his blood.
The man spent 22 days in hospital, eight of them in intensive care, having his blood filtered and two courses of antibiotics, according to the Journal Of The Academy Of Consultation-Liaison Psychiatry.
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