Crohn’s: elemental diet fails to add benefit to anti-TNF maintenance therapy

  • Hirai F & al.
  • J Gastroenterol Hepatol
  • 23 Jun 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In patients with Crohn's disease, there is no added benefit of an amino acid-rich elemental diet (ED) with concomitant anti-TNF therapy compared with anti-TNF therapy alone.

Why this matters

  • ED may not be an effective treatment option for patients receiving maintenance anti-TNF therapy.

Study design

  • Multicenter, prospective cohort study of 72 patients with Crohn’s disease who had positive clinical response to maintenance infliximab or adalimumab (a change in the Crohn’s Disease Activity Index of >70 and
  • Assignment to the ED group (Elental) was based on patient preference and positive tolerability test of ED at 900 kcal/day for 3 days.
  • ED plus anti-TNF therapy (n=37) was compared with anti-TNF therapy without ED (n=35).
  • The primary outcome was cumulative remission rate at 2 years after baseline.
  • Funding: EA Pharma Co., Ltd.

Key results

  • No significant difference between groups in cumulative remission rate at 2 years (60.9% of ED group vs 56.7% of the anti-TNF alone group; P=.98).
  • Adherence to ED was low, with only 29.7% of the ED group consuming ≥900 kcal/day.

Limitations

  • Nonrandomized design.
  • Bias in allocation to the ED group.

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