Effect of a concomitant elemental diet with maintenance anti‐tumor necrosis factor‐α antibody therapy in patients with Crohn's disease: A multicenter, prospective cohort study

Abstract

The addition of ED for Crohn's disease patients who responded to initial anti-TNF induction therapy was not found to improve outcomes. The efficacy of concomitant ED in other clinical settings, such as loss of response, needs to be clarified in the future (UMIN000009789).

Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

“…Out of the 16 studies which compared clinical relapse rates between patients using MEN and those that did not, 9/16 (56%) of the studies demonstrated lower relapse rates in patients using MEN; 8/11 (73%) in adults [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] and 1/5 (20%) in children [ 59 ]. Conversely, in 3/11 (27%) adult and 3/5 (60%) pediatric studies, clinical relapse rates did not differ between patients using MEN against those in the comparator group [ 31 , 60 , 61 , 62 , 63 , 64 ]. In one pediatric study, MEN use led to lower relapse rates only in patients not using any concomitant medication, with no significant differences observed in relapse rates between patients using MEN and azathioprine than those only using azathioprine [ 65 ].…”

Efficacy of enteral nutrition in patients with Crohn’s disease on maintenance anti-TNF-alpha antibody therapy: a meta-analysis

“…EN does not directly induce an increase in anti-TNF-alpha antibody blood concentration or reduce antibody production. However, an increasing number of recent reports have shown how the use of EN in combination with an anti-TNF-alpha antibody is clinically useful due to the add-on effect of EN itself [40][41][42][43][44][45][51][52][53]. In the present review, in which these studies were meta-analyzed, the pooled OR for maintenance of remission or relapse with EN was 2.23 in the fixed effects model and 2.19 in the random effects model.…”

“…In retrospective studies, patients who were able to continue receiving EN for a prolonged period are analyzed as the EN group, enabling assessment of the effect of EN combination therapy; however, recruitment bias cannot be ruled out. According to the report by Hirai et al, although patient adherence was confirmed in the EN group prior to the enrollment in accordance with the protocol for the prospective cohort, only 29.7% were able to continue with EN at the targeted calorific content of 900 kcal over a 2-year period [45]. The authors considered that the low adherence in the EN group was the main reason why the efficacy of combination therapy with EN was not demonstrated.…”

“…enteral nutrition vs conventional therapy: 1), and three articles where the end point was not clinical remission or response. Based on the results of these exclusions, nine articles meeting all criteria were included in this meta-analysis [40][41][42][43][44][45][51][52][53] (Fig. 1).…”

“…In fact, the patients tend to accept elevated severe adverse effect (AE) risks in exchange for clinical efficacy; however, they are not able to accept even mild AE risks if the treatment efficacy is lower or uncertain [39]. In recent years, reports indicating that EN can enhance the therapeutic effect and suppress LOR of anti-TNF-alpha antibody agents have been attracting attention [40][41][42][43][44][45]. Implementation of EN itself is inherently extremely safe, although there are minor concerns such as osmotic diarrhea.…”