-
Welcome to Celiac.com!
You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.
-
Celiac.com Sponsor (A1):
Celiac.com Sponsor (A1-M):
-
Get Celiac.com Updates:Support Our Content
Search the Community
Showing results for tags 'remission'.
-
Celiac.com 08/14/2024 - Refractory celiac disease type II, commonly referred to as RCDII, is a rare and severe form of celiac disease. Unlike typical celiac disease, RCDII does not respond to a gluten-free diet. This condition is marked by the clonal expansion of abnormal intraepithelial lymphocytes, which can lead to high mortality rates due to the lack of effective treatment options. One promising treatment involves the use of tofacitinib, a small-molecule inhibitor targeting specific enzymes known as JAK1 and JAK3. This study explores the potential of tofacitinib to induce clinical remission in patients with RCDII. Study Overview and Methodology This open-label clinical study involved six patients diagnosed with RCDII, who had not responded to previous treatments, including the drug cladribine. Four patients were treated according to the study protocol in the Netherlands, while two patients in Germany received similar treatment outside the protocol. The patients were given 10 mg of tofacitinib twice daily for 12 weeks. The study aimed to assess both the clinical and immunologic responses to the treatment. Baseline Characteristics of Patients At the beginning of the study, all patients exhibited significant symptoms of malabsorption, such as weight loss, diarrhea, abdominal pain, and low levels of albumin in the blood. Small intestine biopsies showed a high percentage of abnormal intraepithelial lymphocytes, ranging from 70% to 90%. Two patients also had ulcerative jejunitis, a severe condition causing ulcers in the small intestine. Histological examinations revealed varying degrees of villous atrophy, a condition where the finger-like projections in the small intestine are damaged, affecting nutrient absorption. Clinical Response to Tofacitinib Treatment All patients completed the 12-week treatment course with tofacitinib. Within a span of two to fourteen days, patients experienced a noticeable resolution of diarrhea and abdominal pain. Additionally, they showed significant weight gain, with a median increase of over 12% by the end of the 12 weeks. One patient with severe ulcerative jejunitis was even able to discontinue total parenteral nutrition by week nine. However, upon discontinuation of tofacitinib, all patients quickly relapsed, experiencing weight loss and a return of symptoms. When tofacitinib treatment was resumed, patients again showed rapid and complete clinical improvement. Immunologic and Histologic Findings The primary immunologic endpoint was to achieve a reduction of at least 20% in the number of abnormal intraepithelial lymphocytes. This goal was not met by any patient. The median percentage of abnormal cells remained relatively unchanged from baseline to the end of the 12-week treatment period. Despite this, four out of six patients showed significant improvement in the histology of their small intestine, indicating mucosal healing. This improvement was particularly evident in patients with ulcerative jejunitis. Adverse Events and Safety Throughout the study, all patients experienced adverse events. The most common was lymphopenia, a condition characterized by low levels of lymphocytes in the blood. One patient suffered a serious adverse event, developing a pulmonary embolism associated with a line sepsis caused by a bacterial infection. This patient continued to receive tofacitinib at a reduced dose of 5 mg twice daily, with continued clinical improvement. No other serious infections were reported, and there was no progression to enteropathy-associated T-cell lymphoma in any patient. Extended Follow-Up and Long-Term Outcomes During an extended follow-up period of up to two years, the patients continued to show persistent clinical remission while on a reduced dose of tofacitinib. The median weight gain further increased, and duodenal biopsies indicated ongoing histologic improvement. Capsule endoscopy revealed complete or near-complete resolution of intestinal ulcerations in patients with ulcerative jejunitis. These findings suggest that tofacitinib not only provides short-term relief but also contributes to long-term clinical remission in patients with RCDII. Implications for Future Treatment of Celiac Disease This study is significant for several reasons. First, it demonstrates that tofacitinib can induce rapid and sustained clinical remission in patients with refractory celiac disease type II, a condition that has been notoriously difficult to treat. Second, the study's findings suggest that while tofacitinib may not reduce the number of abnormal intraepithelial lymphocytes, it effectively mitigates their harmful activity. This functional impact is crucial for improving patient outcomes. For those with celiac disease, particularly the rare and severe RCDII, this study offers hope for a viable treatment option where none previously existed. It also underscores the importance of continued research and clinical trials to explore and refine new therapies. The potential for tofacitinib to change the treatment landscape for RCDII patients is substantial, offering a path to better management and improved quality of life. Read more at: cghjournal.org
-
- histologic
- improvement
- (and 7 more)
-
Celiac.com 12/16/2022 - Recently, an interesting discussion thread popped onto our celiac disease and gluten-free forum. A member of the forum, going by the handle @dixonpete, claims his celiac disease went into remission after treatment with hookworms. Moreover, he claims that he is essentially cured, and able to eat gluten with no side effects, and has had at least one recent negative follow up tTG antibody test to back this up. History of Hookworm Infection to Treat Celiac Disease We've done more than a few articles on the potential to use hookworms to treat celiac disease. We've done a number of articles on hookworms as the potential future of celiac disease treatment, including: Are Intestinal Worms the Future of Autoimmune Disease Treatment? Could Hookworm Infections Help Cure Celiac Disease? Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment Have Celiac Disease? Try a Little Hookworm with that Pasta! Previously, we'd only reported data from various studies, some of which looked promising. Until recently we had never heard directly from anyone claiming to have gone through hookworm treatment firsthand. Because he is the first person we've heard from who claims direct experience with hookworm treatment for celiac disease, the information furnished by @dixonpete to the thread might be of interest to anyone who might be interested in the possibility of receiving hookworm treatment. Hookworms seem to work, at least partly, by blocking the inflammatory response in the gut of the host. One of the benefits of this treatment is that the hookworms may also block the gut's immune response to gluten in people with celiac disease. Could Hookworm Treatment Allow Celiacs to Eat Gluten Again? At this time, there's no data to confirm that hookworm treatment "cures" celiac disease in the classic sense of the word. In theory, if the hookworms were eliminated, then the celiac disease could return. And the hookworms don't reproduce, so you need just the right amount in the gut, but not too much. The current hypothesis is that the hookworms simply block the immune inflammatory response when people with celiac disease eat gluten. But even that remains unclear, and not well-supported by data. Clearly more studies need to be done to verify whether hookworms present a viable alternative for people with celiac disease. A single example of this possibly working in real life isn't enough data to support the claim that the treatment should work for all celiacs. In fact, @dixonpete admits himself that he was suffering from both celiac disease and other conditions that drove his decision. Still, it's a compelling story. For more information, read the full discussion thread and the related articles. If hookworms prove to be effective treatment for celiac disease, would you be willing to consider a hookworm infection to treat your celiac disease? Let us know in the comments below.
- 71 comments
-
- celiac
- celiac disease
- (and 4 more)
-
Celiac.com 08/17/2020 - The case of a man whose celiac disease went into remission after he took an off market drug for alopecia, even though he was eating gluten, is getting some attention from researchers. An alopecia patient at the University Hospitals Leuven, Belgium, tried to control his celiac disease by following a gluten-free diet. After some modest improvement in symptoms, the patient returned to a non-gluten-free diet, and the symptoms returned. The patient chose to continue eating gluten, and to keep an eye on the symptoms. At about that time, he began taking off-label Tofacitinib to treat his alopecia. Tofacitinib is a Janus kinase inhibitor approved for treatment of rheumatoid arthritis and bowel diseases. Tofacitinib inhibits enzymes associated with symptoms of rheumatoid arthritis, but it’s also used to treat alopecia and certain bowel diseases. To the surprise of his clinicians, a follow-up visit showed complete histologic and serologic remission of the man's celiac disease, despite his ongoing consumption of gluten. Blood tests for celiac antibodies all came back in the normal range. The result is intriguing, but is only a single case, and it will require a larger study to reveal whether this might also work in others with celiac disease. Since Tofacitinib has already been approved by the FDA as a safe and effective treatment for several non-celiac conditions, positive studies of it successfully treating celiac disease could mean that people with celiac disease may soon have a new drug option to manage their condition. Still, this case report is only one single patient, and much more research needs to be done before drawing any conclusions about whether this drug will work in others with celiac disease. The clinicians are encouraging further study of the relationship between Tofacitinib and celiac disease remission. At the same time, they advise caution, because Tofacitinib can have potentially serious side effects, and may not be suitable for long-term use. In fact, if Tofacitinib proves useful against celiac disease, it may be especially helpful for people with refractory celiac disease. Read more about the team's report in Annals of Internal Medicine
- 3 comments
-
Celiac.com 01/27/2014 - A team of physicians presents the case of a patient who experienced remission of severe aphthous stomatitis of celiac disease with etanercept. The team included Adey Hasan, Hiren Patel, Hana Saleh, George Youngberg, John Litchfield, and Guha Krishnaswamy. They are variously affiliated with the The Department of Internal Medicine, the Division of Allergy, Asthma and Immunology, and the James H. Quillen VA Medical Center at East Tennessee State University in Johnson City, TN, and with the Departments of Medicine and Pathology at Quillen College of Medicine in Johnson City, TN. The team presents a patient with celiac disease complicated by severe aphthous stomatitis that impairs swallowing, chewing and speaking, which have triggered weight loss, psychosocial problems, and impaired her work performance. The woman tried a variety of topical and systemic medications symptoms, but saw little or no improvement in her symptoms. She consented to treatment with etanercept, and experienced complete remission of aphthous stomatitis, decrease in arthralgia and fatigue and considerable improvement in her quality of life. The team points out that newer biological agents, such as etanercept, might be useful in treating certain celiac disease complications, and may even help to improve patient morbidity. They are calling for further study to determine long-term efficacy and safety of these drugs in the mucosal and/or systemic complications of this disease. Source: Clinical and Molecular Allergy 2013, 11:6. doi:10.1186/1476-7961-11-6
Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8-M):