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Therapeutic efficacy of infliximab on active Crohn's disease under nutritional therapy

Objective. The aim of this investigation was to elucidate retrospectively the therapeutic effect of infliximab in patients with active Crohn's disease (CD) under nutritional therapy. Material and methods. Using a review of the clinical records in 24 nationwide institutions specializing in inflammatory bowel disease, the short-term effect of infliximab in 97 patients with active CD was retrospectively investigated. The Crohn's disease activity index (CDAI) at baseline and after 2 weeks of a single infliximab administration (5 mg/kg) was compared among patients under total parenteral nutrition (TPN group, n=36), those following an elemental or polymeric diet (EN group, n=49) and those without TPN and EN (NN group, n=12). A decrease in CDAI ≥ 70 or a CDAI value <150 at 2 weeks was regarded as effective. Results. There was no difference in CDAI at baseline among the three groups. In each group, CDAI decreased significantly (from 250 (195–290) [median (interquartiles)] to 152 (123–233) in the TPN group, p<0.0001; from 259 (200–325) to 180 (130–238) in the EN group, p<0.0001; from 278 (222–291) to 164 (132–196) in the NN group, p=0.003). Infliximab was effective in 63.9% of patients in the TPN group, in 55.1% of those in the EN group and in 75% of the NN group. There was no statistical difference in efficacy among the three groups (p=0.4). Multivariate logistic regression analysis revealed younger age to be a significant factor related to the efficacy of infliximab. Conclusions. Infliximab is effective in patients with CD under TPN or EN. Age at infliximab administration may be predictive of response to infliximab.