Crohn's Disease Overview of Crohn's Disease Treatments

SedaCrohn

The Wormwood (Artemisia absinthium) preparation SedaCrohn is the only orally used drug that suppresses the tumour necrosis factor alpha and has beneficial effects on Crohn's disease patients.

The suppression of tumour necrosis factor alpha (TNF-alpha) and other interleukines by wormwood (Artemisia absinthium) extracts were reported recently in some in vitro studies (Hatziieremia S et al 2006Hatziieremia S, Gray AI, Ferro V, et al: The effects of cardamonin on lipopolysaccharide-induced inflammatory protein production and MAP kinase and NFB signalling pathways in monocytes/macrophages. British Journal of Pharmacology 149: 188-198, 2006; Lee HG et al 2004Lee HG, Kim H, Oh WK, et al.. Tetramethoxy hydroxyflavone p7F down-regulates inflammatory mediators via the inhibition of nuclear factor kappaB. Ann NY Acad Sci. 1030:555-568, 2004). In one clinical trial, 10 patients suffering from Crohn's disease were given in addition to their basic Crohn's disease therapy 3x750mg dried powdered wormwood for 6 weeks. Ten patients, also randomly selected who met the inclusion criteria served as control group During this period all concomitant Crohn's disease medication was maintained at the baseline dose levels. The average TNF-alpha serum level fell from 24.5±3.5pg/ml at baseline to 8.0±2.5pg/ml after six weeks. The corresponding levels in the control group were 25.7±4.6 (week 0), and 21.1±3.2 (week 6). On the clinical side, CDAI scores fell from 275±15 to below 175±12 in the wormwood group with remission of symptoms in eight patients (CDAI score below 170 or reduction by 70 points), compared to only two in the placebo group (CDAI of placebo group 282±11 at baseline and 230±14 on week 6). Of clinical significance were the findings that wormwood also improved mood of the Crohn's disease patients, as reflected in Hamilton's Depression Scale.

Steroid Sparing Effect of SedaCrohn

Forty patients suffering from Crohn's disease and receiving stable daily doses of steroids participated in this multicenter, randomized, double-blind trial in Germany.

Wormwood is usually standardized based on absinthin; high-quality wormwood should contain at least 0.2% absinthin.( n1) According to the manufacturer Noorherbals, SedaCrohn contains 0.2% to 0.38% absinthin and 0.25% to 1.52% essential oils, depending upon the batch.

Each group was administered SedaCrohn (n=20) or the placebo (n=20) as 3 capsules twice a day for 10 weeks. Patients were assessed for steroid-sparing effects, remission-inducing properties, and quality-of-life improving effects.

After 8 weeks of treatment with SedaCrohn, there was almost complete remission of symptoms in 13 (65%) patients, as compared with none in the placebo group. This remission persisted until the end of the observation period, and the addition of steroids was not necessary.

In the placebo group, 16 patients (80%) showed Crohn's disase exacerbation due to reduction in steroid dose, whereas there were only 2 (10%) such patients in the wormwood group. The exacerbation of Crohn's disease symptoms necessitated the resumption of steroids in 11 patients in the placebo group and 2 patients in the wormwood group.

Self-assessment of the patients showed almost no change in subjective feelings of illness in the placebo group, whereas, in the wormwood group the evaluation indicated significant improvement. The patients who were administered SedaCrohn reported a gradual improvement in mood that was statistically significant at weeks 10 and 12 (P<0.01).

The results suggest that wormwood may have a steroid-sparing effect, in addition to an effect on the mood and quality-of-life in patients with Crohn's disease. The authors attribute these effects to viral elimination by wormwood. However, they do not discount that the effect could be due to immune system modulation by wormwood. In addition, no conclusion can be drawn about the psychological findings because the selection of the patients was not based on depression criteria, but on the criteria of Crohn's disease severity.

The authors conclude that wormwood has not only steroid-sparing effect in patients with Crohn's disease, but that this effect continues for several weeks after the end of the 10-week treatment period. Also, they suggest that there is a subgroup of patients which is resistant to wormwood treatment, since 5 patients showed little response to the wormwood treatment.

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