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BACKGROUND: Loss of response LoR to biologics in Crohn's disease CD is a significant clinical problem. Dietary therapy as a treatment strategy in this setting has not been previously reported. We report the use of dietary strategies using enteral nutrition coupled with the Crohn's Disease Exclusion Diet CDED for LoR to infliximab or adalimumab as a single-centre experience. METHODS: Patients with LoR to a biologic despite dose escalation or combination therapy were treated with partial enteral nutrition PEN by a polymeric formula and the CDED for 12 weeks. Paediatric patients with severe flares received 14 days of exclusive enteral nutrition followed by PEN + CDED as above. All patients were seen at weeks 6 and 12 for follow up. Current and prior treatment, Harvey Bradshaw Index HBI, C-reactive protein CRP and albumin were recorded. Remission was defined as HBI <5 at week 6. RESULTS: Twenty-one patients, mean age 22.1 ± 8.9 years 11 adults and ten children met study criteria. Seventeen patients 81% had used combination therapy, and 10/21 47.6% had failed a second biologic. Seven patients had a prior intestinal resection. Dose escalation had failed in 13/21 62% patients. Clinical remission by physician's global assessment and HBI after 6 weeks was obtained in 13/21 61.9%. Mean HBI decreased from 9.4 ± 4.2 to 2.6 ± 3.8 p < 0.001, mean CRP decreased from 2.8 ± 3.4 to 0.7 ± 0.5 p = 0.005 and mean albumin increased from 3.5 ± 0.6 to 3.8 ± 0.5 p = 0.06. CONCLUSION: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.
Boneh et al. (Thu,) studied this question.