Sugita N, et al. - The efficacy of concomitant elemental diet (ED) therapy to reduce the secondary loss of response to adalimumab (ADA-LOR) was assessed in adult Crohn's disease (CD) patients. In infliximab (IFX)-intolerant or refractory patients, concomitant ED therapy reduced ADA-LOR, in a dose-related manner. By concomitant ED intake, reductions in the tumor necrosis factor-alpha (TNFα) levels could contribute to reducing ADA-LOR in CD patients.

• The physicians divided patients into either an ED (≥900 kcal/day) or a non-ED group (<900 kcal/day).
• They compared cumulative non-ADA-LOR rates between groups.
• They also evaluated the effects of ED intake to reduce ADA-LOR in anti-tumor necrosis factor-alpha (TNFα) naïve and infliximab (IFX)-intolerant or refractory CD patients.
• They measured serum ADA and TNFα levels.

• A total of 117 CD patients were enrolled into the ED (n = 25) or non-ED (n = 92) groups.
• ED intake was not an independent reducing factor for ADA-LOR (adjusted hazard ratio = 0.725; 95% confidence interval: 0.448-1.180; p = 0.196) in all patients, although the cumulative non-ADA-LOR rate was higher in the ED group than in the non-ED group.
• In IFX-intolerant or refractory patients, ED intake was significantly more effective in reducing ADA-LOR than in anti-TNFα naïve patients in a dose-related manner (p for interaction < 0.20).
• Between the groups, serum ADA levels did not differ.
• At week 28, serum TNFα levels were significantly lower in the ED group than in the non-ED group (p = 0.044) and week 52 (p = 0.043).