Rotem Sigall Boneh1, Chen Sarbagili Shabat1, Henit Yanai2,3, Irit Chermesh4, Sivan Ben Avraham1, Mona Boaz5,6, Arie Levine1,3. 1. Pediatric Gastroenterology and Nutrition Unit, PIBD Research Unit, Wolfson Medical Center, Holon, Israel. 2. IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. 3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Gastroenterology Department, Rambam Health Care Campus, Haifa, Israel. 5. Epidemiology and Research Unit E, Wolfson Medical Center, Holon, Israel. 6. Department of Nutrition School of Health Sciences, Ariel University, Ariel, Israel.
Abstract
BACKGROUND: Loss of response [LoR] to biologics in Crohn's disease [CD] is a significant clinical problem. Dietary therapy as a treatment strategy in this setting has not been previously reported. We report the use of dietary strategies using enteral nutrition coupled with the Crohn's Disease Exclusion Diet [CDED] for LoR to infliximab or adalimumab as a single-centre experience. METHODS: Patients with LoR to a biologic despite dose escalation or combination therapy were treated with partial enteral nutrition [PEN] by a polymeric formula and the CDED for 12 weeks. Paediatric patients with severe flares received 14 days of exclusive enteral nutrition followed by PEN + CDED as above. All patients were seen at weeks 6 and 12 for follow up. Current and prior treatment, Harvey Bradshaw Index [HBI], C-reactive protein [CRP] and albumin were recorded. Remission was defined as HBI <5 at week 6. RESULTS: Twenty-one patients, mean age 22.1 ± 8.9 years [11 adults and ten children] met study criteria. Seventeen patients [81%] had used combination therapy, and 10/21 [47.6%] had failed a second biologic. Seven patients had a prior intestinal resection. Dose escalation had failed in 13/21 [62%] patients. Clinical remission by physician's global assessment and HBI after 6 weeks was obtained in 13/21 [61.9%]. Mean HBI decreased from 9.4 ± 4.2 to 2.6 ± 3.8 [p < 0.001], mean CRP decreased from 2.8 ± 3.4 to 0.7 ± 0.5 [p = 0.005] and mean albumin increased from 3.5 ± 0.6 to 3.8 ± 0.5 [p = 0.06]. CONCLUSION: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.
BACKGROUND: Loss of response [LoR] to biologics in Crohn's disease [CD] is a significant clinical problem. Dietary therapy as a treatment strategy in this setting has not been previously reported. We report the use of dietary strategies using enteral nutrition coupled with the Crohn's Disease Exclusion Diet [CDED] for LoR to infliximab or adalimumab as a single-centre experience. METHODS: Patients with LoR to a biologic despite dose escalation or combination therapy were treated with partial enteral nutrition [PEN] by a polymeric formula and the CDED for 12 weeks. Paediatric patients with severe flares received 14 days of exclusive enteral nutrition followed by PEN + CDED as above. All patients were seen at weeks 6 and 12 for follow up. Current and prior treatment, Harvey Bradshaw Index [HBI], C-reactive protein [CRP] and albumin were recorded. Remission was defined as HBI <5 at week 6. RESULTS: Twenty-one patients, mean age 22.1 ± 8.9 years [11 adults and ten children] met study criteria. Seventeen patients [81%] had used combination therapy, and 10/21 [47.6%] had failed a second biologic. Seven patients had a prior intestinal resection. Dose escalation had failed in 13/21 [62%] patients. Clinical remission by physician's global assessment and HBI after 6 weeks was obtained in 13/21 [61.9%]. Mean HBI decreased from 9.4 ± 4.2 to 2.6 ± 3.8 [p < 0.001], mean CRP decreased from 2.8 ± 3.4 to 0.7 ± 0.5 [p = 0.005] and mean albumin increased from 3.5 ± 0.6 to 3.8 ± 0.5 [p = 0.06]. CONCLUSION: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.
Authors: Nicolaus Nazarenkov; Kristina Seeger; Lori Beeken; Ashwin N Ananthakrishnan; Hamed Khalili; James D Lewis; Gauree Gupta Konijeti Journal: Gastroenterol Hepatol (N Y) Date: 2019-03
Authors: Jessica A Fitzpatrick; Sarah L Melton; Chu Kion Yao; Peter R Gibson; Emma P Halmos Journal: Nat Rev Gastroenterol Hepatol Date: 2022-05-16 Impact factor: 73.082
Authors: Berkeley N Limketkai; Zipporah Iheozor-Ejiofor; Teuta Gjuladin-Hellon; Alyssa Parian; Laura E Matarese; Kelly Bracewell; John K MacDonald; Morris Gordon; Gerard E Mullin Journal: Cochrane Database Syst Rev Date: 2019-02-08