Current and emerging therapies for coeliac disease

Coeliac disease is a common enteropathy that occurs in genetically susceptible individuals in response to the ingestion of gluten proteins present in wheat, rye and barley. Currently, the only available treatment for the condition is a strict, life-long gluten-free diet that, despite being safe and often effective, is associated with several challenges. Due to the high cost, particularly restrictive nature and perception of decreased quality of life associated with the diet, some patients are continuously exposed to gluten, which prevents an adequate disease control. Moreover, a subgroup of patients does not respond to the diet adequately, and healing of the small-bowel mucosa can be incomplete. Thus, there is a need for alternative treatment forms. The increasingly understood pathogenetic process of coeliac disease has enabled the identification of various targets for future therapies. Multiple investigational therapies ranging from tolerogenic to immunological approaches are in the pipeline, and several drug candidates have entered phase II/III clinical trials. This Review gives a broad overview of the different investigative treatment modalities for coeliac disease and summarizes the latest advances in this field.

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Acknowledgements

The authors thank the Academy of Finland and the Sigrid Juselius Foundation (K.L.), Emil Aaltonen foundation and the Finnish-Norwegian Medical Foundation (L.K.), the National Health and Medical Research Council of Australia (NHMRC, Investigator Grant APP1176553), and the Mathison Centenary Fellowship, University of Melbourne (J.T.-D.). A.C. holds a Paul Douglas chair in intestinal research.

Author information

Authors and Affiliations

  1. Tampere Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland Laura Kivelä
  2. Children’s Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Laura Kivelä
  3. Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada Alberto Caminero & Maria Ines Pinto-Sanchez
  4. Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA Daniel A. Leffler
  5. Takeda Pharmaceuticals, Cambridge, MA, USA Daniel A. Leffler
  6. Immunology Division, The Walter and Eliza Hall Institute, Parkville, and Gastroenterology Department, The Royal Melbourne Hospital, Parkville, Australia Jason A. Tye-Din
  7. Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland Katri Lindfors
  1. Laura Kivelä