Is Rifaximin Effective in Maintaining Remission in Crohn's Disease?

Abstract

Background: Recent studies indicate that persistent intestinal inflammation in patients with Crohn's disease (CD) might be caused by abnormal intestinal microbiota. This hypothesis may suggest a beneficial effect of antibiotics in CD therapy. So far, guidelines do not recommend antibiotics except in the treatment of complicated CD, and there are few studies on the effects of rifaximin in these patients. Methods: Between December 2011 and December 2012, we performed a blinded randomized trial in 168 patients with a previous history of moderately active CD concerning the efficacy of rifaximin. All the patients had previously achieved remission with standard therapy (prednisone/budesonide). Data from patients receiving 800 mg of rifaximin (83 patients) twice a day for 12 weeks were compared with those from patients who received placebo (83 patients). The primary endpoint was maintaining remission during the follow-up. Results: All the patients (100%; 83/83) on 800 mg of rifaximin were in remission after 12 weeks of treatment in comparison with 84% (70/83) of the placebo group. This significant difference was also persistent at the 24-week follow-up [78% (65/83) vs. 41% (34/83), respectively]. The last evaluation performed at 48 weeks revealed disease activity in 45% (38/83) of the patients of the rifaximin group, i.e. a significant decrease compared with the placebo group [75% (63 of 83)]. Conclusions: Remission previously obtained with standard treatment can be sustained in patients with moderately active CD after the administration of 800 mg of rifaximin.

Can inflammatory bowel disease be permanently treated with short-term interventions on the microbiome?

“…This antibiotic has been found to have broad-spectrum activity against most enteric pathogens, including Gram-positive, Gram-negative, aerobic and anaerobic species [74]. Additionally, randomized-controlled trials have demonstrated superiority of rifaximin when compared with placebo in inducing remission in CD patients [75] as well as sustaining remission in those who have already achieved remission with standard prednisone treatment [76].…”

Maintenance therapy for Crohn’s disease

“…However, studies could not show any benefit of adding antibiotics to maintenance therapy [95]. However, in a randomizedcontrolled trial, the remission rate was still higher in the rifaximin group compared with the placebo group at the end of 1 year of follow-up [106]. Further studies are needed to clarify the role of rifaximin in the maintenance of CD.…”

Practical Considerations and the Intestinal Microbiome in Disease: Antibiotics for IBD Therapy

“…In general, the 4 trials were small in size and determined that clofazimine was not associated with a therapeutic benefit. A 2014 trial by Jigaranu et al [34] found that a 12-week course of twice daily rifaximin (800 mg) in addition to standard therapy maintained remission (CDAI <150) for 12 weeks and coincided with a 100-point drop in baseline remission score. The potential benefit of the rifampin antibiotic class was not seen in the multi-antibiotic trial including 450 mg/day rifabutin by Selby et al [27] .…”

“…The potential benefit of the rifampin antibiotic class was not seen in the multi-antibiotic trial including 450 mg/day rifabutin by Selby et al [27] . Meanwhile, the single dose of rifampin in the 1994 trial by Prantera et al [ 49 ] was likely not responsible for the increased rates of maintained remission in the experimental cohort [34] . Interestingly, Jigaranu et al [34] found that a 12-week dosing regimen of rifaximin gave a durable benefit 36 weeks later.…”

“…Meanwhile, the single dose of rifampin in the 1994 trial by Prantera et al [ 49 ] was likely not responsible for the increased rates of maintained remission in the experimental cohort [34] . Interestingly, Jigaranu et al [34] found that a 12-week dosing regimen of rifaximin gave a durable benefit 36 weeks later. A downside of the study was that significantly more patients taking biologics were in the antibiotic cohort (30 vs. 18 patients) and this may have affected the study outcomes.…”