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

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

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

The drug works by blocking immune cells that drive the serious bowel damage caused by Crohn’s, and offers a much-needed option for hundreds of patients who don’t respond to current treatments.

It means many will be spared an operation to remove damaged sections of their bowel that leaves them with a stoma bag to collect waste.

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

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 aged 19 and found that few treatments were able to keep his disease under control, but being granted early access to risankizumab – which will be available on the NHS at the end of this year – has proved transformational

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

‘But risankizumab is a promising and exciting option. Hard-to-treat patients seem to respond well and the rate 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 triggers it, but it is thought to be linked to an overactive immune system – fighter 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 back passage. This results in frequent flare-ups of pain, bloody diarrhoea and crushing exhaustion.

Most patients, when first diagnosed, will be offered steroids or other types of strong immunosuppressants. These can be highly 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 to take steroids for no longer than a few months at a time.

But in recent years, a new family of drugs called biologics have 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 skin patches caused by psoriasis, as well as psoriatic arthritis, which causes swollen joints, is the latest to show striking benefits.

It interferes with the action of a critical fighter protein called interleukin-23, which drives much of the inflammation seen in Crohn’s.

The drug works by blocking immune cells that drive the serious bowel damage caused by Crohn’s, and offers 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 those who haven’t responded to other biologics or immunosuppressants.

However, experts say most patients on a biologic will have to switch to a new one, usually after a couple of years, as they eventually stop working.

‘Many Crohn’s patients find that their treatment will stop working. In these cases, if they have tried all the drug options, surgery is often the next step,’ says Dr Samaan.

Two large international trials, published in The Lancet last year, found just under half of those who received risankizumab went into remission – which means symptoms are under control – after three monthly infusions. Another study found half of patients who responded stayed in remission after a year.

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

One patient to benefit 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 aged 19 and found that few treatments were able to keep his disease under control, but being granted early access to risankizumab – which will be available on the NHS at the end of this year – has proved transformational.

‘I was facing a life-changing operation that would leave me with a stoma bag to replace my bowel,’ he says. ‘But the past two years are the best I have felt since I was 18. I’m now playing golf, walking the dogs, cycling and doing the things I have had to miss over the years as I haven’t been well enough.’

Neil visits the hospital every two months and feels ‘tired and run down’ for two days after the infusion – but that’s it for side effects.

‘I might have one bad day every couple of months,’ he says, ‘but this treatment has made my life as normal as it could be with Crohn’s.’