Concomitant use of enteral nutrition therapy is associated with sustained response to infliximab in patients with Crohn’s disease

• Published in: European journal of clinical nutrition 2012-11, Vol.66 (11), p.1219-1223
• Main Authors: Sazuka, S, Katsuno, T, Nakagawa, T, Saito, M, Saito, K, Matsumura, T, Arai, M, Sato, T, Yokosuka, O
• Format: Article
• Language: English
• Subjects: 692/699/1503/257/1402; 692/700/565/1436; Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Care and treatment; Clinical Nutrition; Crohn Disease - drug therapy; Crohn Disease - therapy; Crohn's disease; Diseases of the digestive system; Dosage and administration; Drug Tolerance; Enteral feeding; Enteral Nutrition; Epidemiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Immunomodulation; Immunomodulators; Induction therapy; Infliximab; Internal Medicine; Kaplan-Meier Estimate; Logistic Models; Maintenance; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Methods; Middle Aged; Monoclonal antibodies; Nutrition; Nutrition research; Nutrition therapy; Odds Ratio; original-article; Patients; Public Health; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reference Values; Regression analysis; Retrospective Studies; ROC Curve; Therapy; TNF inhibitors; Tube feeding; Tumor necrosis factor-α; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2012.120

Background/Objectives: A significant proportion of Crohn’s disease (CD) patients receiving infliximab (IFX) maintenance therapy show loss of responsiveness despite a good initial response. The factors other than immunomodulators that prevent IFX dose escalation have yet to be fully elucidated. This study was performed to identify clinical factors or concomitant therapies associated with sustained response to IFX. Subjects/Methods: Seventy-four consecutive CD patients who had successful IFX induction therapy between 2002 and 2010 underwent IFX maintenance therapy. Patients showing loss of response to IFX were treated with IFX intensification therapy. Factors involved in the sustained response to IFX were investigated retrospectively. Results: After a median follow-up of 85 weeks, loss of response to IFX was observed in 30 (40.5%) cases. On logistic regression analysis, concomitant use of enteral nutrition (EN) therapy (elemental and/or polymeric formulas) was identified as an independent factor associated with sustained response to IFX. Receiver operating characteristic curve analysis indicated a cutoff value of 600 kcal/day. We divided the patients into the ‘EN group’ (⩾600 kcal/day) and ‘control group’ (