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.
Methods: We have used dietary therapy as a salvage therapy for patients with biologic refractory disease or LoR. All cases of LoR to a biologic treated with dietary therapy as the sole salvage therapy in our unit. Patients with severe flares received 14 days of exclusive enteral nutrition followed by 6 weeks of CDED with Partial Enteral Nutrition (PEN) providing 50% of calories. Patients with non -severe disease received only CDED + PEN 50% for 12 weeks. Current and prior treatment, Harvey Bradshaw Index (HBI), CRP and albumin were recorded. All patients were seen at week 6 & 12 for follow up. Remission was defined as HBI <5 at week 6.
Results: Twenty one patients, mean age 22.1±8.9 years. (11 adults and 10 children) met study criteria. Seventeen patients (81%) had used combination therapy, 10/21 (47.6%) were failing a second biologic. Dose escalation had failed in 13/21 (62%) patients. Clinical remission after 6 weeks was obtained in 13/21 (61.9%). Mean HBI decreased from 9.14±4.05 to 2.5±3.7 (p<0.001), mean CRP decreased from 3.2±3.4 to 1.1±2 (p=0.033) and mean albumin increased from 3.5±0.6 to 3.8±0.5 (p=0.06).
Conclusions: Dietary therapy combining enteral therapy with the CDED may be a useful salvage therapy for patients failing biological therapy despite dose escalation.