Chronotherapy: The science of timing drugs to our Body Clock

Doctors are becoming increasingly interested in the science of chronotherapy – aligning medical treatment to our circadian rhythm or natural Body Clock. Cancer and rheumatoid arthritis are two disease areas where chronotherapy is showing promise.


Philippe Maillol started standard chemotherapy for pancreatic cancer with the drugs infused during the day. But the side effects were hard to bear. He was completely exhausted and suffered extreme nausea for days. Six months ago Philippe switched to treatment at a hospital in Paris where his drug infusions are spaced out during the day, with two happening overnight while he sleeps. The impact on his body is much gentler and he doesn’t need to take anti-nausea drugs which have their own side-effects.

“We have clocks within our cells that govern the metabolism of drugs. So some drugs are best given at night and others during the day,” says Prof Francis Levi, one of the pioneers of chronotherapy. “We have found that chronotherapy reduces the toxicity of treatments and improves the quality of life of patients, by respecting their circadian rhythms,” he explains.

Rheumatoid arthritis

The University of Manchester is conducting a small chronotherapy trial for rheumatoid arthritis. Krystal Fayle is one of those on the trial. Her life is filled with pain. She suffered liver damage from one drug and hair loss from another. So she is hoping that the trial may identify a better treatment. Rheumatoid arthritis is driven by cells in the immune system called T lymphocytes, says Prof David Ray. “These cells each have their own clock, and their inflammatory response varies depending on the time of day,” he explains. The trial is trying to determine the best time to deliver drugs so that they dampen the immune system only when needed.

Prof Ray says: “The processes that drive the disease are only active for part of the 24-hour cycle – so if get our potent drug in at the right time we can avoid exposing patients to toxic drugs throughout the day.”

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