Psoriasis drug that is winning the war on Crohn’s disease

Britons with a debilitating bowel condition could be spared life-changing surgery thanks to a drug used to treat the scaly skin condition psoriasis.

Health chiefs have now approved risankizumab for NHS patients with difficult-to-treat Crohn’s disease.

The drug works by blocking immune cells that cause the severe intestinal damage caused by Crohn’s disease, providing a much-needed option for hundreds of patients who don’t respond to current treatments.

It means many are spared surgery to remove damaged parts of their bowel, leaving them with an ostomy pouch to collect waste.

‘There is a great need for new medication in Crohn’s disease because we have so many patients who do not respond to treatment or find the side effects unpleasant,’ says Dr Mark Samaan, gastroenterologist at Guy’s and St Thomas’ NHS Foundation Trust.

Health chiefs have now approved risankizumab for NHS patients with difficult-to-treat Crohn’s disease (file photo)

‘But risankizumab is a promising and exciting option. Difficult-to-treat patients seem to respond well and the number of side effects is low.’

Crohn’s disease is an incurable condition in which parts of the digestive system become inflamed. Doctors aren’t entirely sure what causes it, but it’s thought to be related to an overactive immune system — fighting cells that are supposed to attack harmful toxins mistakenly destroy healthy tissue in the gut.

The damage can be extensive, affecting the entire digestive tract from the mouth to the anus. This results in frequent flare-ups of pain, bloody diarrhea, and crushing exhaustion.

Most patients are offered steroids or other types of strong immunosuppressants when first diagnosed. These can be very effective at controlling flare-ups, but come with a host of unpleasant side effects, including weight gain, indigestion, and an increased risk of serious infections.

Most patients are advised not to use steroids for more than a few months at a time.

But in recent years, a new family of drugs called biologics has transformed Crohn’s treatment. These work by targeting specific proteins released by the immune system that cause inflammation. Risankizumab, which is used to treat the itchy red patches of skin caused by psoriasis, as well as psoriatic arthritis, which causes swollen joints, is the latest to show striking benefits.

It disrupts the action of a crucial fighting protein called interleukin-23, which causes much of the inflammation seen in Crohn’s disease.

The drug works by blocking immune cells that cause the severe intestinal damage caused by Crohn’s disease, providing a much-needed option for hundreds of patients who don’t respond to current treatments (file photo)

Studies have shown that the drug is highly effective in people who have not responded to other biologics or immunosuppressants.

However, experts say that most patients taking a biologic drug have to switch to a new one, usually after a few years, because they eventually stop working.

‘Many patients with Crohn’s disease find that their treatment no longer works. In these cases, once they’ve tried all drug options, surgery is often the next step,” says Dr. Samaan.

Two large international studies, published last year in The Lancet, found that just under half of those who received risankizumab went into remission – meaning control of symptoms – after three monthly infusions. Another study found that half of the patients who responded remained in remission after one year.

Those taking the drug reported similar incidences of side effects as those taking a dummy version. Experts say it saves surgery for some patients and slows it down for others.

One patient benefiting from this is Neil Berryman, 45, an engineer from Northamptonshire, who was given the drug in 2021 as part of a trial. He was diagnosed with Crohn’s at the age of 19 and found that few treatments could control his disease, but the early access to risankizumab – which will be available on the NHS at the end of this year – has proved transformative.

“I was facing life-changing surgery where I would get an ostomy pouch to replace my bowel,” he says. “But the past two years have been the best I’ve felt since I was 18. I now play golf, walk the dogs, bike, and do the things I’ve had to miss over the years because I wasn’t good enough. ‘

Neil goes to hospital every two months and feels ‘tired and exhausted’ for two days after the infusion – but that’s about it for the side effects.

“I may have a bad day every few months,” he says, “but this treatment has made my life as normal as possible with Crohn’s disease.”