Why Biologics are Ultimaely a Failed Therapy for Crohns Disease

Since its introduction in 2003, a biologic has prevailed as the drug of choice in the treatment of Crohn’s disease. Its dominance for the past two decades is poorly supported by its limited therapeutic efficacy. In 2001, Infectious Diseases Incorporated entered a strategic alliance with the University of Florida which ultimately focused on the potential threat that Mycobacterium avium subspecies paratuberculosis (MAP) constitutes for animal and human health. What has been established is that Crohn’s disease is an immune-mediated disease whose effector is preservation of a dysfunctional proinflammatory response directed against MAP and whose affecter is the widespread presence of MAP in the food supply of industrialized nations. The efficacy of biologics is secondary to their peripheral disruption of the cytokine response to MAP. Biologics fail because they lack the ability to destroy the MAP immune template and hence require continued, costly administration that does not totally preclude the development of bowel penetration and fistula induction. This IDI Perspective presents its synthesis as to why biologics represent a failed therapy for Crohn’s disease.