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What future treatments are you most looking forward to?

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Ulcerative Colitis
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Posted 1/28/2016 7:36 PM (GMT 0)
When I'm laying in bed unwell I have a habit of googling UC treatments that are in development as a way of making myself feel better about the future. As such, I have a shortlist of the treatments that I am most excited about becoming available. I know that these can be knocked out at any stage of development, but hey I can't help but dream of one day having an effective treatment to take when I feel a flare coming on. In no particular order, these are:
- Elafin (Vithera pharmaceuticals and J&J): a genetically engineered bacteria which has been engineered to produce enzymes that ameliorate inflammation at the site of disease.
-Extracellular matrix gel (Asana) - a gel that forms a pseudo-cover over the damaged portion of the colon which results in the replacement of diseases tissue with healthy
-HE3286 (Harbor Biosciences) - a synthetic derivative of a naturally occurring anti-inflammatory steroid, that acts like prednisone etc but doesn't have the immunosuppressive effects.
I'd love to hear what you guys are interested in or excited about?
Posted 1/28/2016 10:23 PM (GMT 0)
Qu biologics Site Specific Immunomodulators are promising.
Posted 1/28/2016 10:54 PM (GMT 0)
I think all of these sound exciting. Do you know when they will be available for us to try?
I am tired of this UC! I want to be healed. I do not want to take all this medicine anymore.
Where can I find this information WorriedUCer?
Thank you
Posted 1/29/2016 12:15 AM (GMT 0)
I have done little research but I am excited for things that are more specific, think vedolizumab

things that will target specific inflammatory agents in the bowels

just a cool thought, not sure if its even being worked on by any major reseracher
Posted 1/29/2016 6:44 AM (GMT 0)
Hi Noelhelp,
I'm actually a clinical researcher by day so am fairly familiar with pharma companies product pipelines etc, so at night when I'm feeling unwell I turn my attention to searching for new UC treatments, or even rheumatoid arthritis treatments and others that may be applicable in UC or inflammatory conditions. For top line stuff I just look to simple websites like www.sciencedaily.com as they report on recent studies, as after a hard day of work the last thing I want to do is read more clinical papers! I also go to www.clinicaltrials.gov and type in ulcerative colitis to see all the new trials for UC and see whether I think any are promising.

Dikid I unfortunately am a bit untrusting of vedolizumab as they have done such large studies which is usually the mark of pharma companies trying to get enough patients to show there's an effect (reading between the lines because the effect is so minimal). That being said there are others such as Jak 1 and 2 inhibitors that may be good, too early to tell though.
Posted 1/29/2016 1:09 PM (GMT 0)
I am really hoping they'll learn enough about the impact of the microbiome on auto-immunity to find some targeted changes to intestinal bacteria that will help.
Posted 1/29/2016 2:59 PM (GMT 0)

FSLondon said...
I am really hoping they'll learn enough about the impact of the microbiome on auto-immunity to find some targeted changes to intestinal bacteria that will help.

This is my hope too. I think that we will see personalized probiotic prescriptions, based on our genetics, and on the composition of our microbiome. It will need to include anerobic microbes, which will require air-tight casings - but all of this should follow from what they are learning about treating c-diff with FMT.

I think the key is re-balancing the cut microbes.

Beyond that, some sort of agents to repair mucosal barrier, like those mentioned in the OP.

Finally, I think we are going to need new medical agents that can erase targeted parts of the immune system's memory. IF we have formed antigens to certain proteins that are healthy, or to certain microbes that are beneficial, then we will need to erase the immune system's memory for those things.
Posted 1/29/2016 3:09 PM (GMT 0)
@WorrriedUcer and @Dikid--isn't ENTYVIO same as vedolizumab? Thanks.
Posted 1/29/2016 3:09 PM (GMT 0)

noelhelp said...
I think all of these sound exciting. Do you know when they will be available for us to try?
I am tired of this UC! I want to be healed. I do not want to take all this medicine anymore.
Where can I find this information WorriedUCer?
Thank you

Unfortunately you would just be switching one med for another.

Unless MAP research starts showing more generalizable results, or we get therapies to reprogram our immune systems, the drugs are maintenance drugs. Prednisone alternatives, inflammation reducers, and gelatin bandaids over ulcers may need to be used on an ongoing basis.

But they will likely be more expensive than the drugs we have now unless we can reform the pharmaceutical industry and runaway pricing.
Posted 1/29/2016 3:55 PM (GMT 0)
For me the next big promising one is tofacitinib; should be out in 2017 at some point. Im registered for the SSI trial that going to happen in June but there is not enough data there to get excited yet. I really dont even look at things until they reach at least the phase II stage because far too many fail before that. Theory is only good in the lab.
Posted 1/29/2016 4:07 PM (GMT 0)

PamSmith said...
@WorrriedUcer and @Dikid--isn't ENTYVIO same as vedolizumab? Thanks.

Yes.
Posted 1/29/2016 5:36 PM (GMT 0)
Stelara should be approved for CD this year and hopefully UC soon after.
Posted 1/29/2016 7:22 PM (GMT 0)

ks1905 said...
Stelara should be approved for CD this year and hopefully UC soon after.

Considering the first ever trial for UC is only just starting now (havent even started enrolling in Canada yet) "soon" is a bit unrealistic. Mechanistically it shouldnt work for UC anyway since it acts on the Th1 type of immunity and UC is a Th2 type response. I turned down the opportunity to take part in that trial because I dont have any confidence in it.
Posted 1/29/2016 8:00 PM (GMT 0)

Marauder93 said...

ks1905 said...
Stelara should be approved for CD this year and hopefully UC soon after.

Considering the first ever trial for UC is only just starting now (havent even started enrolling in Canada yet) "soon" is a bit unrealistic. Mechanistically it shouldnt work for UC anyway since it acts on the Th1 type of immunity and UC is a Th2 type response. I turned down the opportunity to take part in that trial because I dont have any confidence in it.

The only reason I said soon is because usually after biologicals get approved for CD then it happens after that. Even if it is not approved in the US the insurance companies will usually pay if you failed the other drugs first.

Doesn't it target the same area as Entyvio? IL-12 & IL-23
Posted 1/29/2016 10:44 PM (GMT 0)
You've mentioned Elafin - i used to be excited over it as well but i remember reading somewhere that unfortunately it turned out to be a failure. Now there are studies if it could work for celiakia but they already know it won't be good for uc. However, maybe you've got some other (more optimistic) info on Elafin? :)
Posted 1/29/2016 11:26 PM (GMT 0)

Marauder93 said...
For me the next big promising one is tofacitinib; should be out in 2017 at some point. Im registered for the SSI trial that going to happen in June but there is not enough data there to get excited yet. I really dont even look at things until they reach at least the phase II stage because far too many fail before that. Theory is only good in the lab.

That is a bummer about stelara.

I am sure i sound like a broken record but my GI sent quite a few people to the Xeljanz trial here in my area and she said she hadn't had any responders. Granted, the people she was sending were people like me, non-responders to everything.

I am thankful I am done with it all. it's nice to wake up and take zero pills, no medical bills, no RX scripts. I bet the pharmacist doesn't even remember who I am. It's been a few months. smilewinkgrin
Posted 1/30/2016 12:06 AM (GMT 0)
Curious to know how well Entyvio is working out for people since it's the latest one. Even though I don't have my colon anymore I like to keep up with the latest medications and things on the horizon. Since UC runs in my family, I worry about my kids inheriting this lovely disease.
Posted 1/30/2016 12:32 AM (GMT 0)
I'd also be curious to know how people are finding Entyvio (vedolizumab) for their UC? I guess one benefit for the pharma companies is that our drugs are so crappy that they don't have much competition for their new drugs!
Ewafromwarsaw - do you remember where you saw that? I'll have a look as I haven't researched Elafin for a little while but weren't doing any clinical trials last time I checked, which would lead me to think that even if it's unsuccessful pre-clinically for UC if they try it in celiac and it works then the cross-over wouldn't be such a leap. I'll look into further.

DBwithUC: I don't care if it's a maintenance treatment. If I could get a maintenance treatment that was effective when I was starting to flare such as an anti-inflammatory hydrogel then I'd be happy. I know a "cure" is the ultimate goal but there's nothing wrong with starting to live your life before that and an effective treatment that had few side effects would help with that.
I personally don't think biologics are the way forward because given our rudimentary knowledge of the immune system, we will always have serious unintended effects with messing around with it.
Posted 1/30/2016 1:51 AM (GMT 0)

ks1905 said...

Marauder93 said...

ks1905 said...
Stelara should be approved for CD this year and hopefully UC soon after.

Considering the first ever trial for UC is only just starting now (havent even started enrolling in Canada yet) "soon" is a bit unrealistic. Mechanistically it shouldnt work for UC anyway since it acts on the Th1 type of immunity and UC is a Th2 type response. I turned down the opportunity to take part in that trial because I dont have any confidence in it.

The only reason I said soon is because usually after biologicals get approved for CD then it happens after that. Even if it is not approved in the US the insurance companies will usually pay if you failed the other drugs first.

Doesn't it target the same area as Entyvio? IL-12 & IL-23

Entyvio doesnt target those interleukins and since there is literally NO evidence for Stelara in UC, Id be super surprised if an insurance company would cover it. Sorry to be a pessimist but those are just the facts Im afraid
Posted 1/30/2016 1:54 AM (GMT 0)

WorriedUCer said...

I personally don't think biologics are the way forward because given our rudimentary knowledge of the immune system, we will always have serious unintended effects with messing around with it.

Biologics =/= immune system targets. They are just drugs made my living cells. Eg. Insulin is a biologic. But all of our drugs target the immune system. Considering this disease is a result of a dysfunctional immune system, how do you plan on fixing it without targeting it?
Posted 1/30/2016 3:55 AM (GMT 0)
Xeljanz-Tofacitinib

Imagine we're some time off from this next hypothetical but wouldn't it be something if they could create a gut specific oral biologic? Someday...
Posted 1/30/2016 9:45 AM (GMT 0)
H

Marauder93 said...
Biologics =/= immune system targets. They are just drugs made my living cells. Eg. Insulin is a biologic. But all of our drugs target the immune system. Considering this disease is a result of a dysfunctional immune system, how do you plan on fixing it without targeting it?

I actually disagree fundamentally with the point that "this disease is a result of a dysfunctional immune system". Just because our immune system is activated does not mean that it is dysfunctional. Given the fact that the less than 5% of our bacterial microbiota is able to be cultured, and don't even get me started on the virome, that is a gigantic amount of dark matter living within us (no pun intended). Stomach ulcers were once thought to be a stress response by our bodies until they found the cause, helicobacter pylori infection. I personally don't believe the solution is tinkering with our immune system.
I also disagree with the comparison to insulin which is a well known hormone with a fairly narrow metabolic pathway. The same most definitely cannot be said for IBD biologics. Progressive multifocal leukoencelopathy is one such example. Tuberculosis is another. Insulin does not have this side effect profile.
Posted 1/30/2016 11:36 AM (GMT 0)

WorriedUCer said...


I actually disagree fundamentally with the point that "this disease is a result of a dysfunctional immune system". Just because our immune system is activated does not mean that it is dysfunctional. Given the fact that the less than 5% of our bacterial microbiota is able to be cultured, and don't even get me started on the virome, that is a gigantic amount of dark matter living within us (no pun intended). Stomach ulcers were once thought to be a stress response by our bodies until they found the cause, helicobacter pylori infection. I personally don't believe the solution is tinkering with our immune system.


yeah
Posted 1/30/2016 12:17 PM (GMT 0)
I am with FSLondon on this one. I recently had a discussion about this very subject with my GI. He was saying how VSL is just a blanket approach right now and we won't be able to make headway with until we start to identifying specific bacteria.
Posted 1/30/2016 5:37 PM (GMT 0)

Marauder93 said...

ks1905 said...
Stelara should be approved for CD this year and hopefully UC soon after.

Considering the first ever trial for UC is only just starting now (havent even started enrolling in Canada yet) "soon" is a bit unrealistic. Mechanistically it shouldnt work for UC anyway since it acts on the Th1 type of immunity and UC is a Th2 type response. I turned down the opportunity to take part in that trial because I don't have any confidence in it.

Just FYI - One of the Doctors I suggested to you, can get Stelara now on compassionate grounds. In fact I was approved but decided to go the Entyvio route instead.
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