Rifaximin may benefit Crohn's disease in new study
Rifaximin, an antibiotic that has been approved for treating IBS-D*, may also benefit patients with Crohn's disease (CD), suggests a study presented at the Crohn's & Colitis Congress (CCC) 2018.
The double-blind study randomized 24 patients with moderate to severe CD (CD Activity Index [CDAI] 220–450) in a 1:1 ratio to receive oral rifaximin 550 mg twice daily or placebo for 8 weeks. This was followed by an open-label phase whereby nonresponders to placebo received rifaximin for 8 weeks. Patients in the rifaximin arm had significantly longer disease duration at baseline than those in the placebo arm (mean, 11.2 vs 5.9 years; p=0.05). [CCC 2018, abstract P142]
During the double-blind phase, clinical response was fourfold higher with rifaximin than with placebo (38.5 percent vs 9.1 percent, p=0.055), with rifaximin-treated patients having a lower disease activity than control patients based on CDAI by 8 weeks.
“Rifaximin has a moderate impact on clinical disease activity in moderate-severe CD, even in patients with a significant disease burden and prior exposure to one or more biologic therapies,” said lead author Dr Scott Lee of the University of Washington School of Medicine in Seattle, Washington, US.
Improvements were also seen for quality of life ─ as assessed by the Inflammatory Bowel Disease Questionnaire ─ and biochemical assessments for inflammatory biomarkers, including C-reactive protein and erythrocyte sedimentation rate, although these were not significantly different between the treatment arms.
Ten patients in the placebo arm who were nonresponders received rifaximin in the open-label phase. Of the five subjects who completed the open-label study, one had clinical response by week 8 but none were in remission based on CDAI.
There were no new safety signals identified, with similar rates of adverse events observed in both treatment arms.
According to the researchers, abnormal intestinal microbiota can lead to persistent intestinal inflammation in CD, leading to the hypothesis that antibiotics may be beneficial in CD therapy.
“[A]ntibiotic treatments for IBD have previously shown limited effectiveness,” said Lee and co-authors. “These results offer renewed hope for the use of antibiotics in treating CD.”