Summary: Celiac.com 01/23/2023 - Celiac disease is an auto-immune condition in which eating gluten damages the intestinal lining of the gut. Currently, the only proven celiac treatment is a gluten-free diet. However, perfect gluten-free compliance is hard to sustain, and accidental gluten exposure is common. Studies show that even the most diligent patients likely get exposed to small doses of gluten on a regular basis. Because of this, there is substantial interest in developing new drugs and therapies to treat celiac disease, usually in tandem with an existing gluten-free diet. A team of researchers recently set out to review existing and upcoming clinical trial programs for pharmacologic agents for celiac disease. The research team included Michael Klonarakis; Christopher N. Andrews; Maitreyi Raman; Remo Panaccione; and Christopher Ma. They are variously affiliated with theDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada; the Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada; the Alberta Collaboration of Excellence for Nutrition in Digestive Diseases, Calgary, Alberta, Canada; and the Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Their team conducted a narrative review by searching MEDLINE, Embase, the Cochrane CENTRAL Library and clinicaltrials.gov. They then summarized the pathophysiology of celiac disease and the specific steps that could be favorably influenced by pharmacologic treatment, and then assessed the evidence in favor of current and future drug targets, including trials of peptidases, gluten sequestrants, tight junction regulators, anti-transglutaminase 2 therapies, immune tolerizing agents, advanced biologics and small molecules, and microbiome-targeted strategies. Finally, they highlighted the variables key to conducting successful celiac disease trials, including finding suitable study groups, evaluating results in the context of a gluten challenge, and interpreting celiac-specific clinical and histologic outcomes. After balancing these factors and accurately appraising the evidence, the team described potential celiac disease pharmacotherapies of the future. From their assessment, the team concludes that celiac disease sufferers need pharmacologic options, either to complement a gluten-free diet in the case of gluten exposure, or for treating refractory disease. With numerous drugs currently in development, the team expects approvals for the first generation of celiac drug treatments within the next 5 years. Color me skeptical, but the idea that new and effective treatments for celiac disease are only 5 years away is one we've heard for at least 15+ years now. The failures are legion. However, any major step forward will give people with celiac disease much to look forward to, so here's hoping. Stay tuned for more on this and related stories. Read more in Alimentary Pharmacology & Therapeutics
