Does Helminthic Therapy help in the treatment of Crohn's Disease?

Question

I heard on the radio the other day about helminthic therapy for Crohn's Disease.

Helminthic therapy, a type of immunotherapy, is the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the ova of a helminth. Helminths are parasitic worms such as hookworms and whipworms. Helminthic therapy consists of the inoculation of the patient with specific parasitic intestinal nematodes (helminths).

Is that a feasible alternative for, say, Humira?

Answer 1

The Cochrane Collaboration do systematic reviews of the published scientific evidence - they look at all the information that is available.

This year, they looked at this issue:

• Garg SK, Croft AM, Bager P. Helminth therapy (worms) for induction of remission in inflammatory bowel disease. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009400. DOI: 10.1002/14651858.CD009400.pub2

The question asks about Crohn's disease, but they looked further - at IBD:

Inflammatory bowel disease (IBD) is comprised of two disorders: ulcerative colitis and Crohn’s disease. These disorders have both distinct and overlapping symptoms, but the underlying cause remains incompletely understood.

They only found two moderately small trials, and neither of them were able draw any strong conclusions about the safety or the effectiveness of the treatment.

Currently, there is insufficient evidence to allow any firm conclusions regarding the effectiveness and safety of helminths used to treat patients with IBD. The only information available relating to clinical improvement in patients with active ulcerative colitis comes from one small study. We do not know how safe helminths are when used in patients with ulcerative colitis and Crohn's disease.

So, as of January 2014, it was too early to say whether such a treatment is going to work or is going to be safe.

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Just for completeness, Cochrane looked into Adalimumab (a.k.a. Humira) too:

The current evidence suggests that the TNF-alpha blocking agents infliximab, adalimumab, and certolizumab pegol are effective maintenance therapy in Crohn's disease. However, the use of these medications needs to be weighed against the potential risk of serious side effects, particularly infection.