Crohn's disease is a chronic inflammatory bowel disease affecting about 500,000 people in the United States. Treatment has expanded from steroids and immunosuppressants to biologic drugs targeting specific immune pathways — TNF inhibitors, integrin blockers, and IL-12/23 inhibitors. Many people now achieve remission, but flares still happen and surgery remains common.
What's actually going on in research
Trials are testing JAK inhibitors, anti-TL1A antibodies that block a newer inflammatory pathway, and combinations of biologics to see if hitting two targets works better. Researchers are studying stricture prevention drugs, fistula-healing treatments, and whether early aggressive treatment changes the disease course. Some trials target specific microbiome signatures.
Anti-TL1A antibodies
TL1A is an immune signal that drives inflammation in Crohn's disease and appears especially active in people with strictures and fistulas. Blocking it may reach complications that current drugs struggle with.
JAK inhibitors
Upadacitinib was FDA-approved for Crohn's in 2023, joining other JAK inhibitors that work as pills and can induce remission quickly. Trials are comparing them to biologics and testing them earlier in disease.
Microbiome targeting
Studies are testing whether specific bacterial strains or fecal microbiota transplant can restore healthy gut bacteria and reduce inflammation. Results have been mixed, but research continues.
What to know before you search
Eligibility typically depends on disease activity measured by endoscopy or biomarkers, location of disease in the digestive tract, prior treatment history, and whether complications like strictures or fistulas are present.
What types of trials are currently open
- Induction trials — Testing whether a new drug can bring active Crohn's into remission, usually over 12 to 16 weeks.
- Maintenance trials — Testing whether a drug keeps people in remission over one to two years after initial treatment.
- Fistula trials — Studies focused on closing and healing fistulas, which affect about one-third of people with Crohn's.
- Combination trials — Testing whether using two biologics together works better than one, particularly for people who haven't responded to standard treatment.
- Observational studies — Following people with Crohn's to track disease progression, identify who responds to which treatments, and understand long-term outcomes.
Recently added Crohn's Disease trials
Regenerative Endoscopy in Refractory Perianal Crohn's Disease
Perianal fistulizing Crohn's disease (pCD) represents a severe phenotype of Crohn's disease, affecting approximately 20-30% of patients and resulting in chronic drainage, recurrent sepsis, impaired continence, and reduced quality of life. Despite optimization of biologics, antibiotics, and surgical drainage, durable healing remains difficult to achieve. Conventional surgical approaches such as curettage or seton management alone yield modest remission rates, and repeated procedures may compromise sphincter integrity. Autologous mechanically processed tissue stromal vascular fraction (tSVF) is derived from adipose tissue using non enzymatic methods and can be prepared and reinjected during the same operative session. Unlike culture-expanded or enzymatically isolated cell products, mechanical tSVF retains a native adipose micro architecture containing stromal cells, perivascular elements, endothelial progenitors, extracellular matrix components, and bioactive cytokines. This heterogeneous microenvironment is hypothesized to exert immunomodulatory, pro angiogenic, and regenerative effects that may enhance tract healing while preserving sphincter function. Mechanical processing avoids enzymatic digestion, cell expansion, and complex laboratory infrastructure, making it potentially more feasible and cost effective in real world settings. However, high quality prospective data evaluating mechanically processed autologous tSVF specifically in refractory complex pCD remain limited, and feasibility data are required before undertaking a large randomized trial. This single arm pilot feasibility study is therefore designed to evaluate procedural feasibility, safety, and preliminary signals of clinical and radiological healing following mechanical tSVF injection in refractory complex perianal Crohn's disease. The results will inform design parameters, outcome variability, and sample size estimation for a future definitive multicenter trial.
Impact of Advanced Crohn's Disease Therapies on Sleep Quality
The goal of this observational study is to measure changes in sleep quality before and after starting treatment with advance therapy in adult with Crohn disease. The main question it aims to answer is: what is the association between response to therapy and sleeping patterns? Participants who are about to begin advanced treatment will be asked to wear a Fitbit device before end after treatment initiation to monitor sleep patterns and sleep quality, complete a sleep diary and a sleep quality questionnaire. The follow-up period will last 26 weeks, during which disease severity and response to treatment will be assessed.
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