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P350. The effect of infliximab therapy on nutritional status in patients with Crohn's disease

T. Yamamoto1, M. Shiraki1, S. Umegae1, K. Matsumoto1, 1Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan

Background

Tumour necrosis factor (TNF)-α is typically considered as the most potent among cytokines associated with inflammation and cachexia. Therefore, it might be logical to expect TNF-α blocking agents like infliximab influence appetite and promote weight gain. However, in spite of this possibility, up to now, the impact of infliximab on nutritional status in patients with Crohn's disease (CD) has not been evaluated as a major treatment outcome. This prospective study was designed to assess the effect of infliximab therapy on nutritional status in patients with CD.

Methods

Fifty consecutive patients with active CD received infliximab (5 mg/kg) at weeks 0, 2 and 6 as remission induction therapy, and then at 8 weeks intervals as maintenance therapy. Patients were followed for 60 weeks. CD activity index (CDAI) and body mass index (BMI) were monitored. A fall in CDAI by ≥70 was defined as response to therapy, while CDAI<150 meant clinical remission.

Results

At week 10, 39 patients (78%) responded to infliximab induction therapy. BMI significantly increased during these 10 weeks (P < 0.0001). The mean increase in BMI was significantly higher in patients who responded to infliximab versus patients who did not (P = 0.03). Further, at weeks 30 and 60, 35 patients (70%) and 33 (66%) were in remission, respectively. The mean increase in BMI was significantly higher in patients who maintained remission versus patients not in remission (week 30, P = 0.02; week 60, P = 0.01). Patients with a low baseline BMI (<18.5) and those with small bowel involvement achieved a higher increase in BMI as compared to patients with BMI ≥18.5 or patients without small bowel involvement.

Conclusion

In this study, infliximab therapy was associated with improvement of patients' nutritional status, notably patients who responded to this biologic. Additionally, in patients with malnutrition and small bowel involvement, the nutritional impact of infliximab was higher.