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Review
. 2020 Feb;55(2):133-141.
doi: 10.1007/s00535-019-01634-1. Epub 2019 Oct 22.

Efficacy of enteral nutrition in patients with Crohn's disease on maintenance anti-TNF-alpha antibody therapy: a meta-analysis

Fumihito Hirai  1   2 , Teruyuki Takeda  3   4 , Yasumichi Takada  4 , Masahiro Kishi  3   4 , Tsuyoshi Beppu  3   4 , Noritaka Takatsu  3 , Masaki Miyaoka  4 , Takashi Hisabe  4 , Kenshi Yao  4 , Tosiharu Ueki  4
Affiliations
Review

Efficacy of enteral nutrition in patients with Crohn's disease on maintenance anti-TNF-alpha antibody therapy: a meta-analysis

Fumihito Hirai et al. J Gastroenterol. 2020 Feb.

Abstract

Enteral nutrition (EN) is effective in Crohn's disease (CD) patients and has been shown to have an inhibitory effect on loss of response to anti-tumor necrosis factor (TNF)-alpha antibody therapy; however, the current level of evidence is not sufficient. The objective of this meta-analysis was to determine whether EN in combination anti-TNF-alpha antibody therapy is useful in maintaining remission. PubMed was used to identify all relevant studies. A total of nine articles were identified including one randomized control trial, two prospective cohort studies, and six retrospective cohort studies. We performed a meta-analysis on all these articles to assess the remission maintenance effect of EN (n = 857). The remission or response maintenance effect in the EN group was 203/288 (70.5%), which was higher than 306/569 (53.8%) in the non-EN group. The odds ratio for long-term remission or response using fixed effects model and random effects model were 2.23 (95% CI 1.60-3.10) and 2.19 (95% CI 1.49-3.22), respectively. The usefulness of EN was unclear in two prospective studies that were conducted immediately after remission induction with anti-TNF-alpha antibody therapy was detected. Differences in the definition of relapse and the observation period among articles were considered to be limitations. This analysis suggests that EN is effective for maintaining remission in patients already in remission or response as a result of anti-TNF-alpha antibody maintenance therapy.

Keywords: Anti-TNF-alpha antibody; Crohn’s disease; Enteral nutrition; Meta-analysis.

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Conflict of interest statement

Fumihito Hirai received lecture fees from Abbvie GK, EA Pharma Co., Ltd, Janssen Pharmaceutical K.K, Mochida Pharmaceutical Co., Ltd and Mitsubishi Tanabe Pharma Co.

Figures

Fig. 1
Fig. 1
Algorithm demonstrating article search of this meta-analysis. Finally, nine studies were included in this study
Fig. 2
Fig. 2
Forest plot of odds ratio for long-term remission. The odds ratio for long-term remission using fixed effects model and random effects model was 223 (95% CI 160–310) and 219 (95% CI 149–322), respectively
Fig. 3
Fig. 3
Funnel plot of odds ratio for long-term remission
See this image and copyright information in PMC

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