New Developments in Celiac Disease Treatment

Abstract

Celiac disease (CD) is a common autoimmune disease affecting around 1% of the population. It consists of an immune-mediated enteropathy, triggered by gluten exposure in susceptible patients. All patients with CD, irrespective of the presence of symptoms, must endure a lifelong gluten-free diet (GFD). This is not an easy task due to a lack of awareness of the gluten content in foods and the extensive incorporation of gluten in processed foods. Furthermore, a GFD imposes a sense of limitation and might be associated with decreased quality of life in CD patients. This results in gluten contamination in the diet of four out of five celiac patients adhering to a GFD. Furthermore, one in three adult patients will report persistent symptoms and two in three will not achieve full histological recovery when on a GFD. In recent years, there has been extensive research conducted in the quest to find the holy grail of pharmacological treatment for CD. This review will present a concise description of the current rationale and main clinical trials related to CD drug therapy.

Old and New Adjunctive Therapies in Celiac Disease and Refractory Celiac Disease: A Review

“…The 0.5-mg dose showed an effect on exploratory endpoints including a 26% decrease in celiac disease patient-reported outcome symptomatic days ( p = 0.017), a 31% increase in improved symptom days ( p = 0.034), a 50% or more reduction from baseline of the weekly average abdominal pain score for 6 or more of 12 weeks of treatment ( p = 0.022), and a decrease in the non-gastrointestinal symptoms of headache and tiredness ( p = 0.010). However, in 2022 a phase 3 clinical trial was suspended after an interim analysis showed no significant effectiveness [ 21 ]. More high-quality data are needed to consider this molecule for possible adjunctive therapies in CD.…”

“…Currently, a plethora of phase-II trials have been recently published or are ongoing with promising results [ 21 ]. Unfortunately, today no novel, effective therapies are available for the treatment of CD and RCD.…”

From an understanding of etiopathogenesis to novel therapies—what is new in the treatment of celiac disease?

“…This process is mediated by a key tight junction modulator–zonulin. Production of zonulin is induced–mainly–by bacteria overgrowth and gluten that binds to receptor CXCR3 in erythrocytes ( Fasano, 2020 ; Machado, 2023 ). On the other hand, zonuline activates tight junction relaxation, causing the delivery of gliadin peptides to lamina propria.…”

Unraveling the Immunopathological Landscape of Celiac Disease: A Comprehensive Review

“…First and foremost, adherence to a GFD presents substantial challenges for many CD patients. The scarcity of suitable gluten-free alternatives, the higher cost of these products, and the inherent challenges of maintaining strict dietary regimens over extended periods make compliance arduous [93]. In fact, the adherence rates of a GFD among CD patients vary widely, ranging between 42% and 91%, and in many cases, less than 50% of patients maintain this regimen consistently [94].…”