Effectiveness of Concomitant Enteral Nutrition Therapy and Infliximab for Maintenance Treatment of Crohn’s Disease in Adults

Abstract

BackgroundOne of the problems associated with infliximab (IFX) treatment for Crohn’s disease (CD) is loss of response during maintenance therapy.AimsThe aim of this multicenter, retrospective, cohort study was to determine whether enteral nutrition (EN) added to the IFX therapy regimen is effective for maintaining remission in adult CD patients.MethodsPatients with CD who had started IFX therapy between April 2003 and March 2008 at any one of the seven participating medical centers and who met the following inclusion criteria were enrolled in the study: remission after triple infusions of IFX followed by IFX maintenance therapy every 8 weeks, and follow-up data available for ≥1 year. Remission was defined as a C-reactive protein (CRP) level of <0.3 mg/dL, and recurrence was defined as an increase in CRP to ≥1.5 mg/dL or shortening of the IFX interval. Patients were classified by EN dosage into two groups (EN group and non-EN group). The cumulative remission period and related factors were analyzed.ResultsOf the 102 adult CD patients who met the inclusion criteria, 45 were in the EN group and 57 were in the non-EN group. The cumulative remission rate was significantly higher in the EN group than in the non-EN group (P = 0.009). Multivariate analysis revealed that EN was the only suppressive factor for disease recurrence (P = 0.01).ConclusionsThe results demonstrate that among this CD patient cohort, EN combined with IFX maintenance treatment was clinically useful for maintaining remission.

Advances in Nutrition of Patients with Inflammatory Bowel Diseases

“…Parenteral nutrition of patients with IBDs shows numerous adverse side effects with increased risk of systemic infections; and most importantly is not beneficial for IBD control [96,97]. No positive effects of parenteral nutrition on maintenance of remissions and in its induction were demonstrated in both CD and UC.…”

Specialized enteral nutrition therapy in Crohn’s disease patients on maintenance infliximab therapy: a meta-analysis

“…The minimum amount of enteral nutrition support was reported to be ⩾600 kcal/ day in the study by Sazuka and colleagues [Sazuka et al 2012]. In all the studies, patients were allowed to receive an oral diet to supplement their Hirai et al 2013;Sazuka et al 2010;Tanaka et al 2006] were given an overall global grade of 'moderate', while the fifth study [Yamamoto et al 2010] was given a score of 'strong' because of its prospective nature (Table 2).…”

“…The overall rate of clinical remission was assessed in four studies [Hirai et al 2013;Sazuka et al 2010;Tanaka et al 2006;Yamamoto et al 2010 (Figure 2). The number needed-to-treat with combination therapy of infliximab and specialized enteral nutrition to maintain clinical remission is four patients.…”

Long-Term Outcome of Endoscopic Balloon Dilatation for Strictures in Patients with Crohn’s Disease

“…However, 25–40% of patients with CD with a good initial response to anti-TNF-α show loss of response during maintenance therapy mostly within the first 6 months after induction [5, 6]. Several studies have reported that concomitant therapies such as immunomodulators and an elemental diet are useful for preventing the loss of response to anti-TNF-α within a few months [7, 8]. These findings suggest that the optimization of therapy is important for improving prognosis in patients with CD.…”