The role of Mycobacterium avium subspecies paratuberculosis (MAP) in the pathogenesis of Crohn’s disease (CD) has been strongly debated for many years. MAP is the known aetiological agent of Johne’s disease, a chronic enteritis affecting livestock. At present, due to the paucity of high-quality data, anti-MAP therapy (AMT) is not featured in international guidelines as a treatment for CD. Although the much-quoted randomised trial of AMT did not show sustained benefits over placebo, questions have been raised regarding trial design, antibiotic dosing and the formulation used. There are several lines of evidence supporting the CD and MAP association with uncontrolled and controlled trials demonstrating effectiveness, including a retrospective review of cases treated at our own institution. Here, we provide an overview of the evidence supporting and refuting AMT in CD before focussing on updates of the current research in the field, including the ongoing trials with the novel RHB-104 formulation and the MAP vaccine trial. While controversial, gastroenterologists are often asked about long-term combination antibiotic therapy for CD. There has been broadcast and social media coverage surrounding this, particularly with regard to current trials. Although patients should not be deterred from treatments of proven effectiveness, this review aims to help with commonly asked questions and highlights our own approach for the use of anti-MAP in specific circumstances.
- antibiotic therapy
- Crohn's disease
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Contributors SH, EJ, GA, BA-H, JHT: manuscript planning, writing, editing and submission. JS: manuscript editing, responsible for overall content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SH has received lecture fees from Pfizer, Janssen and Takeda, and meeting support fees from Pfizer, Janssen, Vifor Pharma, Dr Falk Pharma and Ferring. EJ received lecture fees from Ferring and ad board fees from Dr Falk Pharma. JH-T is a stockholder for HAV Vaccines and has a patent diagnostic test issued and a patent MAP antibodies pending.
Provenance and peer review Not commissioned; externally peer reviewed.