Abstract
Prospective trials of anti-mycobacterial antibiotic therapy (AMAT) have proven efficacious in Crohn’s disease (CD) but use as first-line treatment in CD has not been evaluated. This paper reports the outcomes of patients with CD treated with first-line AMAT. This paper consists of a case series of treatment-naïve CD patients who received AMAT as first-line treatment between 2007 and 2014 at a single center. AMAT treatment consisted of rifabutin, clofazimine and clarithromycin, plus either ciprofloxacin, metronidazole or ethambutol. Symptoms, inflammatory blood markers, colonoscopy and histology results, in addition to, the Crohn’s Disease Activity Index (CDAI) were tabulated from patients’ clinical records, and descriptive statistics were conducted. A Wilcoxon signed-rank test assessed the difference in CDAI scores before and while on AMAT. The statistical significance was set at 5%. Clinical remission (CDAI < 150) with rapid improvement in clinical symptoms and inflammatory markers was seen in all eight patients receiving AMAT as sole therapy by 6 weeks. In all eight patients, the median CDAI score decreased significantly, from 289 prior to treatment to 62 at the 12-month follow-up (p < 0.001). Follow-up colonoscopies showed healing of CD ulcers, no visible mucosal inflammation, restoration of normal vascular patterns and complete mucosal healing on histology samples. AMAT as first-line therapy demonstrated a rapid improvement of Crohn’s disease (not previously seen when used as second-line therapy).
Highlights
Anti-inflammatory and immunosuppressive agents have evolved to be the standard of care for Crohn’s disease (CD) [1]
One candidate pathogen is Mycobacterium avium subspecies paratuberculosis (MAP), which is the causative organism of a near-identical inflammatory bowel disease in ruminants and primates, termed “Johne’s disease” [6]
It belongs to the Mycobacterium avium complex (MAC) group, one of many non-tuberculous mycobacteria (NTM), which are distinct from the other mycobacteria group named the Mycobacterium tuberculosis complex (MTBC), of which some cause pulmonary tuberculosis
Summary
Anti-inflammatory and immunosuppressive agents have evolved to be the standard of care for Crohn’s disease (CD) [1]. A number of biological agents targeting various cytokines and components of the inflammatory cascade have been approved for CD [2,3], expanding anti-inflammatory options for patients. One candidate pathogen is Mycobacterium avium subspecies paratuberculosis (MAP), which is the causative organism of a near-identical inflammatory bowel disease in ruminants and primates, termed “Johne’s disease” [6]. It belongs to the Mycobacterium avium complex (MAC) group, one of many non-tuberculous mycobacteria (NTM), which are distinct from the other mycobacteria group named the Mycobacterium tuberculosis complex (MTBC), of which some cause pulmonary tuberculosis
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