Crohn's disease, fatigue, and infliximab: is there a role for cytokines in the pathogenesis of fatigue?
OBJECTIVE
To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients.


METHODS
Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals.


RESULTS
After placebo infusion, fatigue scores decreased within 3 d (3.5 points +/- 1.1, P <or= 0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points +/- 1.4, P <or= 0.05). Quality of life was increased at the end of the study compared to baseline values (138.6 +/- 9.4 vs 179.4 +/- 6.7; P <or= 0.005), whereas depression scores were decreased (20.4 +/- 9.4 vs 11.3 +/- 2.2; P <or= 0.01). No correlation between the severity of fatigue and the level of cytokines was observed.


CONCLUSIONS
The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.
Minderhoud
Itta M
IM
Department of Gastro-enterology, Univerisity Medical Centre Utrecht, Utrecht, The Netherlands.
Samsom
Melvin
M
Oldenburg
Bas
B
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D003424:Crohn Disease / Q000097:blood / Q000150:complications* / Q000523:psychology; D016207:Cytokines / Q000097:blood / Q000502:physiology*; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006306:Health Surveys; D006801:Humans; D000069285:Infliximab; D016753:Interleukin-10 / Q000097:blood / Q000502:physiology; D020382:Interleukin-18 / Q000097:blood / Q000502:physiology; D015850:Interleukin-6 / Q000097:blood / Q000502:physiology; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000502:physiology
D000911:Antibodies, Monoclonal; D016207:Cytokines; D005765:Gastrointestinal Agents; D020382:Interleukin-18; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002097:C-Reactive Protein; D000069285:Infliximab