Dietary therapies induce rapid response in pediatric Crohn’s
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Identifying which patients respond quickly to dietary therapies for Crohn’s disease may help indicate which ones will succeed long term and which ones might do better on a different therapy, according to study results.
“Rapid response would support further use of dietary therapy, might delay or avoid the need for corticosteroids and provide insight into dietary triggers of inflammation in the responsive patient,” Arie Levine, MD, of the pediatric gastroenterology and nutrition unit at Wolfson Medical Center in Israel, and colleagues wrote. “On the other hand, patients that are unresponsive might not need continued dietary therapy, allowing rapid transition to other therapies.”
Researchers collected data from the randomized trial of the CD exclusion diet (CDED) comprising 73 children with mild to moderate CD. They randomly assigned patients to receive either exclusive enteral nutrition (EEN; n = 34) or the CDED with partial enteral nutrition (n = 39). They examined patients at baseline and at weeks 3 and 6 of the diet. They defined remission as a CD activity index score below 10 and response as a decrease of 12.5 or clinical remission. They also assessed inflammation using a measurement of C-reactive protein.
At week 3 of the diet, investigators found that 82% of patients in the CDED group and 85% of patients in the EEN group exhibited rapid response or remission on their diet, with median levels of CRP decreasing from 24 mg/L to 5 mg/L. At week 6 of the diet, 46 of 49 patients had response or remission on the diet, and 81% of those patients had been in clinical remission by week 3.
In their analysis, researchers found that remission at week 3 increased the odds for remission by week 6 (OR = 6.37; 95% CI, 1.6-25), and poor compliance reduced the odds of remission at week 6 (OR = 0.75; 95% CI, 0.012-0.46).
“In an era of personalized therapy, it is important to recognize the triggers for the disease, which patients are susceptible and reduce exposure in those susceptible patients,” Levine and colleagues wrote. “A short empiric trial with diet may allow us to identify those patients with inflammation triggered by diet, using dietary response as the indicator. Thus, in a dietary responsive patient, this response demonstrates that diet plays a pivotal role in that individual patient’s inflammation, while this may not be the case in a compliant patient showing no response.”
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