Long-term durability of infliximab maintenance therapy incorporating plant-based diet in inflammatory bowel disease

Abstract

Background: The new therapeutic modality incorporating a countermeasure against a westernized diet, i.e., a plant-based diet, showed far better outcomes than current standards in inflammatory bowel disease (IBD). Infliximab is widely used for induction and subsequent scheduled maintenance therapy in patients with IBD. However, the efficacy of infliximab diminishes over time. In the present study, we investigated the durability of scheduled infliximab maintenance therapy incorporating plant-based diet in IBD.

Methods: This was a prospective single-group trial at tertiary hospitals. Infliximab maintenance therapy was indicated in patients with severe disease or those who were unresponsive to conventional therapy. Infliximab (5 mg/kg body weight) was infused every 8 weeks on an inpatient basis, and plant-based diet, a lacto-ovo-vegetarian diet, was served three- or four-times during hospitalization. Patients were instructed to continue the diet after discharge. Durability was assessed using the Kaplan-Meier method.

Results: Twenty-four patients [16 with Crohn's disease (CD), eight with ulcerative colitis (UC)] were included: median age 27.5 years old, disease duration 53.5 months, and concomitant use of immunosuppressant 21%. Intensification of infliximab was employed in 46% of patients. There was no significant difference in durability rates between CD and UC. Durability rates were 87% at both 5 and 10 years. Plant-based diet score in the median follow-up period of 9.3 years, which indicates adherence to the plant-based diet, was significantly higher than the baseline score.

Conclusions: Infliximab maintenance therapy incorporating plant-based diet yielded a high durability rate of 87% at 5 years in patients with IBD.

Keywords: Inflammatory bowel disease (IBD); environmental factor; infliximab; maintenance therapy; plant-based diet (PBD).

Figure 1

Schedule of infliximab maintenance therapy after or without induction therapy. The number of patients is 15 for the former and nine for the latter. During hospitalization (yellow paint), infliximab was infused, and a PBD was served. PBD, plant-based diet.

Figure 2

Infliximab maintenance therapy during hospitalization. PBD, plant-based diet.

Figure 3

Indication for infliximab maintenance therapy. IPF therapy, infliximab and a plant-based diet as first-line therapy. CD, Crohn’s disease; PBD, plant-based diet; UC, ulcerative colitis.

Figure 4

Kaplan-Meier curve for the durability of infliximab maintenance therapy.

Figure 5

Change overtime in PBDS. Green, yellow, and black columns show positive, negative, and final score for PBDS, respectively (mean ± SD). All three scores in the short (median duration after the first hospitalization provided by plant-based diet was 1 year) and long term (median duration 9 years and 3 months) were significantly different from those at baseline (*) (Table 3). PBDS, plant-based diet score; SD, standard deviation.