Specialized enteral nutrition therapy in Crohn's disease patients on maintenance infliximab therapy: A meta-analysis

Douglas L. Nguyen, Lena B. Palmer, Emily T. Nguyen, Stephen A. McClave, Robert Martindale, Matthew L. Bechtold

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: Many patients with Crohns disease on infliximab maintenance therapy have recurrent symptoms despite an initial clinical response. Therefore, concomitant therapies have been studied. We conducted a meta-analysis to assess the effect of specialized enteral nutrition therapy with infliximab versus infliximab monotherapy in patients with Crohns disease. Methods: A comprehensive search of multiple databases was performed. All studies of adult patients with Crohns disease comparing specialized enteral nutrition therapy (elemental or polymeric diet with low-fat or regular diet) with infliximab versus infliximab monotherapy without dietary restrictions were included. Meta-analysis was performed using the Mantel Haenszel (fixed effect) model with odds ratio (OR) to assess for clinical remission. Results: Four studies (n = 342) met inclusion criteria. Specialized enteral nutrition therapy with infliximab resulted in 109 of 157 (69.4%) patients reaching clinical remission compared with 84 of 185 (45.4%) with infliximab monotherapy [OR 2.73; 95% confidence interval (CI): 1.734.31, p ≤ 0.01]. Similarly, 79 of 106 (74.5%) patients receiving enteral nutrition therapy and infliximab remained in clinical remission after one year compared with 62 of 126 (49.2%) patients receiving infliximab monotherapy (OR 2.93; 95% CI: 1.665.17, p ≤ 0.01). No publication bias or heterogeneity was noted for either outcome. Conclusions: The use of specialized enteral nutrition therapy in combination with infliximab appears to be more effective at inducing and maintaining clinical remission among patients with Crohns disease than infliximab monotherapy.

Original languageEnglish (US)
Pages (from-to)168-175
Number of pages8
JournalTherapeutic Advances in Gastroenterology
Volume8
Issue number4
DOIs
StatePublished - Jul 6 2015

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Nutrition Therapy
Enteral Nutrition
Crohn Disease
Meta-Analysis
Maintenance
Therapeutics
Odds Ratio
Infliximab
Confidence Intervals
Publication Bias
Fat-Restricted Diet

Keywords

  • Crohn's disease
  • enteral nutrition
  • infliximab
  • meta-analysis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Specialized enteral nutrition therapy in Crohn's disease patients on maintenance infliximab therapy : A meta-analysis. / Nguyen, Douglas L.; Palmer, Lena B.; Nguyen, Emily T.; McClave, Stephen A.; Martindale, Robert; Bechtold, Matthew L.

In: Therapeutic Advances in Gastroenterology, Vol. 8, No. 4, 06.07.2015, p. 168-175.

Research output: Contribution to journalArticle

Nguyen, Douglas L. ; Palmer, Lena B. ; Nguyen, Emily T. ; McClave, Stephen A. ; Martindale, Robert ; Bechtold, Matthew L. / Specialized enteral nutrition therapy in Crohn's disease patients on maintenance infliximab therapy : A meta-analysis. In: Therapeutic Advances in Gastroenterology. 2015 ; Vol. 8, No. 4. pp. 168-175.
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abstract = "Objectives: Many patients with Crohns disease on infliximab maintenance therapy have recurrent symptoms despite an initial clinical response. Therefore, concomitant therapies have been studied. We conducted a meta-analysis to assess the effect of specialized enteral nutrition therapy with infliximab versus infliximab monotherapy in patients with Crohns disease. Methods: A comprehensive search of multiple databases was performed. All studies of adult patients with Crohns disease comparing specialized enteral nutrition therapy (elemental or polymeric diet with low-fat or regular diet) with infliximab versus infliximab monotherapy without dietary restrictions were included. Meta-analysis was performed using the Mantel Haenszel (fixed effect) model with odds ratio (OR) to assess for clinical remission. Results: Four studies (n = 342) met inclusion criteria. Specialized enteral nutrition therapy with infliximab resulted in 109 of 157 (69.4{\%}) patients reaching clinical remission compared with 84 of 185 (45.4{\%}) with infliximab monotherapy [OR 2.73; 95{\%} confidence interval (CI): 1.734.31, p ≤ 0.01]. Similarly, 79 of 106 (74.5{\%}) patients receiving enteral nutrition therapy and infliximab remained in clinical remission after one year compared with 62 of 126 (49.2{\%}) patients receiving infliximab monotherapy (OR 2.93; 95{\%} CI: 1.665.17, p ≤ 0.01). No publication bias or heterogeneity was noted for either outcome. Conclusions: The use of specialized enteral nutrition therapy in combination with infliximab appears to be more effective at inducing and maintaining clinical remission among patients with Crohns disease than infliximab monotherapy.",
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