Digestive Health

10 March 2015

Promising coeliac therapies on the horizon

When people with coeliac disease consume foods that contain gluten, their immune response leads to intestinal damage, malnutrition and other problems – but new developments may change all that.


Currently, a gluten free diet is the only way to manage coeliac disease. But new drugs in clinical trials with humans, as well as more in the pre-clinical phase, may one day allow people with the disorder to enjoy gluten again.

Still years from commercial availability

These options are still years from commercial availability, but early results have been encouraging, according to a review of the drug pipeline in Gastroenterology Report.

"Based on data on ClinicalTrials.gov, there are two investigational products we are aware of which may enter large confirmatory trials in the not too distant future," said lead author Dr. Klaus Gottlieb, senior medical director of the immunology and internal medicine department for Quintiles, a company that provides bio-pharmaceutical development services and consulting in Durham, North Carolina.

Read: Feeding choices may raise babies' risk of coeliac disease

"One of them is an enzyme that splits the molecule in wheat that causes coeliac disease, gluten, into smaller harmless products and another one promises to make the gut less leaky and thus prevent potentially toxic substances (from) reaching deeper layers where they may cause inflammation," Gottlieb said.

Two million Americans and 3.5 million Europeans have coeliac disease, although more than half in the U.S. are not diagnosed, the authors say. People with the disorder must avoid eating gluten, a protein in wheat, rye and barley. If people with coeliac disease consume foods that contain those grains, their immune response leads to intestinal damage, malnutrition and other problems.

Several therapies show promise

Several new therapies have shown promise in human trials, appearing at least somewhat effective. None have yet entered safety trials, the final step before Food and Drug Administration approval and commercial availability.

It's still hard to say when one of these options will reach the market, but if all goes well it could happen in three to five years, Gottlieb told Reuters Health by email.

Read: Eat well without dairy or gluten

For one potential oral therapy, patients take a mixture of two enzymes that split the gluten molecule into smaller harmless products. In a trial of adults with coeliac disease, those taking this drug had no change in their intestinal biopsies after eating gluten, while those taking a placebo did have evidence of injury to the intestinal lining.

However, symptoms were similar in both groups.

Three daily doses of another drug, designed to control an inflammatory process in the intestines, did appear to reduce diarrhoea, indigestion and abdominal pain symptoms in one trial.

Aimed at suppressing immune response

Several others in earlier stages of development are aimed at suppressing the immune response to gluten and preventing intestinal inflammation.

Before the drugs are approved, it's hard to say if they will allow people with coeliac disease to eat gluten in small amounts, large amounts, or without restriction, Gottlieb said.

Read: Early gluten exposure no protection against coeliac disease

"If they eat a lot of gluten, they may still have some symptoms and perhaps other long-term health consequences," he said. Some may be best to take right before eating gluten and others might be more effective when taken on a regular schedule.

Read More:

Gluten damage raises hip fracture risk

Gluten-free diet may lift 'brain fog'

Are you really gluten intolerant?

Image: Coeliac disease from Shutterstock


Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

Ask the Expert

Digestive Health Expert

Dr. Estelle Wilken is a Senior Specialist in Internal Medicine and Gastroenterology at Tygerberg Hospital. She obtained her MBChB in 1976, her MMed (Int) in 1991 and her gastroenterology registration in 1995.

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules