title: Efficacy of concomitant elemental diet therapy in scheduled infliximab therapy in patients with Crohn's disease to prevent loss of response.
abstract: BACKGROUND
  Loss of response (LOR) to infliximab (IFX) has become an important clinical issue for patients with Crohn's disease (CD). Elemental diet (ED) therapy has been established as a nutrition therapy for CD in Japan. ED therapy can reduce antigen exposure and is both efficacious and safe.
  
  
  OBJECTIVE
  To evaluate the efficacy of concomitant ED therapy in maintaining regular IFX infusion in patients with CD.
  
  
  METHODS
  We retrospectively studied 125 patients with luminal CD treated with scheduled IFX maintenance therapy with a regular dosage. Patients were classified into two groups: the ED group with intake ≥ 900 kcal/day and the non-ED group with intake <900 kcal/day. When clinical LOR was detected on the basis of disease activity, laboratory parameters, or endoscopic findings, the physician discontinued the infusion schedule of IFX. We investigated the efficacy of ED therapy for sustaining the scheduled IFX maintenance therapy.
  
  
  RESULTS
  With the exception of ED intake, no significant differences were found in patient characteristics between the ED group and the non-ED group. The ED group was significantly superior to the non-ED group (p = 0.049) in sustaining scheduled IFX maintenance therapy. It is well known that ED therapy is more effective for small bowel lesions than colonic lesions in CD. When comparing ileitis and ileocolitis patients with CD, the ED group was significantly superior to the non-ED group (p = 0.015).
  
  
  CONCLUSIONS
  Concomitant ED therapy is effective in maintaining scheduled IFX maintenance therapy in patients with luminal CD in order to prevent LOR.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan, nkamata@med.osaka-cu.ac.jp.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kamata
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Oshitani
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Watanabe
authors.forename: Shuhei
authors.initials: S
authors.lastname: Hosomi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Noguchi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yukawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yamagami
authors.forename: Matsatsugu
authors.initials: M
authors.lastname: Shiba
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000188:drug therapy*; D004361:Drug Tolerance; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D000069285:Infliximab; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab