Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience

Background/Aims: Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD.Methods: This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points.Results: Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI <150). Mean CDAI of patients decreased significantly after 12 weeks of EEN (388.8±74.8 vs. 160.0±25.2, P<0.001). Perianal fistulas showed clinical response (drainage decreased by >50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m2 at week 12 (P=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (P<0.001 and P=0.006 respectively).Conclusions: EEN appears to be an effective and well tolerated therapy for induction of remission in anti-TNF refractory adult CD. More data from prospective trials with larger number of patients is required.

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Golimumab in adolescents with Crohn’s disease refractory to previous tumor necrosis factor antibody

10.21203/rs.2.21120/v1 ◽

2020 ◽

Author(s):

Judith Pichler ◽

Nima Memaran ◽

Wolf-Dietrich Huber ◽

Christoph Aufricht ◽

Bettina Bidmon-Fliegenschnee

Keyword(s):

Crohn’S Disease ◽

Tumor Necrosis Factor ◽

Crohn's Disease ◽

Tumor Necrosis ◽

Activity Index ◽

Rescue Therapy ◽

Disease Activity Index ◽

Full Blood Count ◽

Faecal Calprotectin ◽

Necrosis Factor

Abstract Background Inducing and maintaining clinical remission in children with Crohn’s disease (CD) is associated with treatment with antibody to tumor necrosis factor (TNF)-α such as infliximab or adalimumab. In the treatment of paediatric CD, there are no data about the use of a third introduced subcutaneous TNF-antibody, golimumab, Methods We evaluated the efficacy of golimumab for adolescents with moderate/severe CD. Retrospective analyses were done in all 7 (5 girls) adolescents who received golimumab at a median age of 17 years for a median of 7.2 months. Paediatric Crohn’s disease activity index (PCDAI), full blood count, inflammatory markers, use of corticosteroids and adverse events were recorded. Results With golimumab, 5 of the 7 children were PCDAI responders and 2 entered remission (PCDAI<10). There was a significant increase in haematocrit after 2 weeks, faecal calprotectin was significantly reduced after 4 weeks compared to baseline. Out of five children, steroid withdrawal was possible in one and steroid reduction in two cases. There were no serious side effects. Conclusion With moderate/severe CD, golimumab induced and maintained clinical response. The majority of children were PCDAI responders, in most steroid sparing was possible. Golimumab might be an effective rescue therapy in refractory CD.

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Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Nutrients ◽

10.3390/nu12041012 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1012

Author(s):

Melinda Moriczi ◽

Gemma Pujol-Muncunill ◽

Rafael Martín-Masot ◽

Santiago Jiménez Treviño ◽

Oscar Segarra Cantón ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Disease Activity ◽

Clinical Remission ◽

Activity Index ◽

Newly Diagnosed ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition ◽

Paediatric Crohn’S Disease

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.

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Association between Fecal Calprotectin and Mucosal Healing in Pediatric Patients with Crohn’s Disease Who Have Achieved Sustained Clinical Remission with Anti-Tumor Necrosis Factor Agents

Gut and Liver ◽

10.5009/gnl20300 ◽

2021 ◽

Author(s):

Yoo Min Lee ◽

Sujin Choi ◽

Byung-Ho Choe ◽

Hyo-Jeong Jang ◽

Seung Kim ◽

...

Keyword(s):

Crohn’S Disease ◽

Tumor Necrosis Factor ◽

Crohn's Disease ◽

Clinical Remission ◽

Tumor Necrosis ◽

Pediatric Patients ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Necrosis Factor

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Efficacy of tumor necrosis factor-alpha inhibitors in fistulising perianal Crohn’s disease

Orvosi Hetilap ◽

10.1556/oh.2013.29770 ◽

2013 ◽

Vol 154 (49) ◽

pp. 1943-1948 ◽

Cited By ~ 1

Author(s):

Renáta Bor ◽

Klaudia Farkas ◽

Anita Bálint ◽

Mónika Szűcs ◽

Szabolcs Ábrahám ◽

...

Keyword(s):

Crohn’S Disease ◽

Tumor Necrosis Factor ◽

Crohn's Disease ◽

Tumor Necrosis Factor Alpha ◽

Tumor Necrosis ◽

Activity Index ◽

Necrosis Factor Alpha ◽

Factor Alpha ◽

One Year ◽

Necrosis Factor

Introduction: Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn’s disease. Aim: The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn’s disease. Method: Responses to therapy was determined using Crohn’s Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy. Results: After 12 weeks the perianal activity was decreased in more than 80% of the cases, and the complete remission rate was about 60%. After one year of therapy about one third of the patients had fistula closure, but after cessation of the biological therapy recurrence of fistulas was detected in every second patient. In most cases additional immunosuppressive therapy was necessary during biological treatment. During the one-year therapy period additional surgical treatments were performed in 45% of patients; seton insertion and abscess drainage were the most frequent procedures. Conclusions: Tumor necrosis factor-alpha inhibitor therapy is effective in the treatment of perianal Crohn’s disease, however, additional immunosuppressive drugs and rectum sparing surgical procedures were necessary during the one-year treatment period. Because of the high rate of fistula recurrence, long term tumor necrosis factor-alpha treatment may be useful. Orv. Hetil., 154(49), 1943–1948.

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