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P556. Concomitant use of enteral nutrition therapy is associated with sustained response to infliximab in patients with Crohn's disease

S. Sazuka1, T. Katsuno1, T. Nakagawa1, K. Saito1, S. Minemura1, A. Oyamada1, D. Maruoka1, T. Matsumura1, M. Arai1, O. Yokosuka1, 1Chiba university hospital, Department of Gastroenterology, Chiba, Japan

Background

A significant proportion of Crohn's disease (CD) patients receiving infliximab (IFX) maintenance therapy show loss of responsiveness, despite a good initial response. The factors other than immunomodulators that prevent IFX dose escalation have yet to be fully elucidated. We reported the clinical factors or concomitant therapies associated with sustained response to IFX (European Journal of Clinical Nutrition (2012) 66, 1219–1223). For a longer-term evaluation, we performed an extension study for more 2 years.

Methods

Seventy-four consecutive CD patients who had successful IFX induction therapy between 2002 and 2010 underwent IFX maintenance therapy and followed them till 2012. Patients showing loss of response to IFX were treated with IFX intensification therapy. Factors involved in the sustained response to IFX were investigated retrospectively.

Results

After a median follow-up of 85 weeks, loss of response to IFX was observed in 30 (40.5%) cases. On logistic regression analysis, concomitant use of enteral nutrition (EN) therapy (elemental and/or polymeric formulas) was identified as an independent factor associated with sustained response to IFX. Receiver operating characteristic curve analysis indicated a cutoff value of 600 kcal/day. We divided the patients into the ‘EN group’ (>600 kcal/day) and ‘control group’ (<600 kcal/day). The cumulative number of loss of response was significantly lower in the EN group (odds ratio: 0.3019, P = 0.0167). Kaplan–Meier analysis confirmed the significantly lower rate of loss of response in the EN group (P = 0.0303). Type of EN formula did not affect the results.

Conclusion

This 10-year cohort study demonstrates concomitant use of EN at a dose of ≥600 kcal/day yields a sustained response to IFX maintenance therapy in patients with CD. The results of this study indicated that along with concomitant immunomodulators and smoking cessation, loss of response to IFX in CD patients appears to be delayed by use of EN ≥600 kcal/day. Moreover, the economic merit of concomitant EN is superior to intensification of IFX. Concomitant EN should be reconsidered in the clinical management of patients with CD treated with anti-TNF-a regimens.