Influence of nutritional status on the therapeutic effect of infliximab in patients with Crohn’s disease

• Published in: Surgery today (Tokyo, Japan) Japan), 2016-08, Vol.46 (8), p.922-929
• Main Authors: Sumi, Ryoko, Nakajima, Kiyokazu, Iijima, Hideki, Wasa, Masafumi, Shinzaki, Shinichiro, Nezu, Riichiro, Inoue, Yoshifumi, Ito, Toshinori
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Body Mass Index; Crohn Disease - complications; Crohn Disease - drug therapy; Female; Gastrointestinal Agents - therapeutic use; Humans; Infliximab - therapeutic use; Male; Malnutrition - etiology; Medicine; Medicine & Public Health; Middle Aged; Nutrition Assessment; Nutritional Status - physiology; Original Article; Prospective Studies; Surgery; Surgical Oncology; Treatment Outcome; Young Adult
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-015-1257-5

Purpose Crohn’s disease (CD) is a refractory inflammatory bowel disease of unknown etiology, frequently complicated by malnutrition. It is thought that the delayed wound healing associated with this malnutrition in CD patients might adversely affect the therapeutic benefits of infliximab (IFX). Therefore, we investigated the effects of nutritional status on IFX treatment. Methods We assessed nutritional status and CD activity when IFX therapy was initiated and following the third dose, 6 weeks later. Nutritional status was assessed using the body mass index (BMI) and nutritional risk index (NRI), whereas CD activity was assessed using the CD activity index (CDAI). Results All patients with a BMI ≥ 18.5 kg/m 2 at the time of IFX therapy met the effective criteria for the CDAI, and IFX treatment was considered responsive in these patients. Furthermore, IFX treatment was responsive, with a high level of effectiveness, in all five subjects (31.3 %) with NRI scores of 97.5 and above with no risk of malnutrition ( p  = 0.037). Conclusions Our results suggest that nutritional status does influence the therapeutic effect of IFX in CD patients. The response rate to IFX treatment thus could be improved by optimizing the nutritional status. We recommend comprehensive nutritional assessment and intervention prior to IFX treatment schedules.