Low-Dose Naltrexone (LDN) Treatment for Crohn's Disease (CD): A Tertiary Care Center Experience
Am J Gastroenterol
Purpose: In recent years, there have been many advances in the treatment of CD therapy; including the development of anti-tumor necrosis factor alpha antibodies. However, despite these advances, about 20% of patients do not respond to treatment. An effective and safe agent for these refractory patients is needed. Recently, LDN, an opioid antagonist, has demonstrated efficacy in patients with CD in 2 small studies. This study reports our experience utilizing LDN for patients with refractory CD.
Methods: This is a retrospective case series looking at 9 patients (6 women / 3 men) from a single tertiary care IBD center with active CD who were treated with open-label 4.5 mg LDN between 1/2007 and 10/2010. All patients were treated for 12 weeks as per previous studies. Charts were reviewed and patient demographics, laboratory studies including ESR, CRP, liver tests, hematocrit before and after treatment, were recorded. In addition, an assessment of each patient's response to treatment was made based on the patient's symptoms including number of stools, abdominal pain, and the development of any complications from their CD. All patients had colonoscopy or imaging demonstrating active CD prior to treatment.
Results: 2 / 9 (22%) had subjective improvement in symptoms (less stools and abdominal pain). None of the patients achieved symptomatic remission with LDN treatment. LDN was safe and well tolerated without any significant effect on liver tests noted. In the 2 patients that had a response to treatment, as soon as the medication was stopped, their symptoms worsened and returned to baseline. One of these two patients resumed LDN treatment, but her symptoms continued to be active. At the end of 12 weeks of LDN treatment, all 9 patients required additional treatment for their refractory CD.
Conclusion: In this open label series, LDN treatment was effective in only a small minority of patients with refractory CD. More research is needed to determine which patients might benefit from LDN therapy.