Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn's disease

Hanai, Hiroyuki; Iida, Takayuki; Takeuchi, Ken; Arai, Hajime; Arai, Osamu; Abe, Jinrou; Tanaka, Tatsuo; Maruyama, Yasuhiko; Ikeya, Kentaro; Sugimoto, Ken; Nakamura, Toshio; Nakamura, Kouichi; Watanabe, Fumio

doi:10.1016/j.dld.2012.03.007

Cited by 63 publications

(70 citation statements)

References 30 publications

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“…50 In most participants, CD was located in both the small and large intestines. Induction therapies included parenteral nutrition, 50,52 central venous feeding, 50 prednisolone, 50,55 infliximab, 50,52 6-mercaptopurine (6-MP), 50 enteral nutrition 52 or surgery. 52 Only two studies 52,55 reported criteria used for the diagnosis of CD.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

“…The full text of the remaining 36 records was examined, of which 12 (representing eight unique studies) were included in the review. 28,[50][51][52][53][54][55][56][57][58][59][60] Of the eight included studies, one RCT [52][53][54] and one nRCT 28,59,60 were represented in multiple publications. Throughout this review, these two studies will be cited according to their corresponding original publications.…”

Section: Literature Searchmentioning

confidence: 99%

“…The study and participant characteristics of the three included RCTs 50,52,55 are summarised in Table 1. Of three RCTs, two were conducted in Japan 50,52 and one in the UK.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

“…Of three RCTs, two were conducted in Japan 50,52 and one in the UK. 55 A total of 179 participants were randomised across three RCTs with individual trial sample size ranging from 33 55 to 95 50 participants.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

“…normal/free diet) through self-inserted feeding tube 50,52 or oral intake. 50,52,55 In one trial, 52 participants in the elemental nutrition group were asked to take half of the daily calories through elemental nutrition (i.e. 'half-elemental diet') and the other half from unrestricted diet.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Tsertsvadze

Gurung

Court

et al. 2015

Health Technology Assessment

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BackgroundAlthough enteral nutrition has been shown to be a viable treatment option for the management of active Crohn’s disease (CD), the evidence regarding its clinical benefits compared with standard treatments (e.g. steroids) for maintaining remission in patients with CD has been inconsistent. If enteral nutrition was to be effective, the use of drugs such as steroids and immunosuppressive drugs could be reduced, thereby reducing the likelihood of adverse events associated with these medications.ObjectivesThis systematic review aimed to assess the clinical effectiveness and cost-effectiveness of elemental nutrition (a type of enteral nutrition) for maintenance of remission in patients with CD.Data sourcesMajor bibliographic databases (e.g. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews) were searched from inception to August/September 2013. Searches were not limited by study design, language or publication date. Websites for relevant organisations and references of included studies were checked.MethodsExperimental randomised and non-randomised controlled trials (RCTs and nRCTs) reporting clinical effectiveness and cost-effectiveness of elemental nutrition in the maintenance of remission in patients with CD were eligible. Study selection, data extraction and risk of bias (RoB) assessment were performed independently. Risk ratios (RRs) and mean differences (MDs) were pooled using a random-effects model. Heterogeneity was assessed via forest plots, Cochran’sQand theI2statistics. Overall, quality of evidence for each outcome was rated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.ResultsEight studies (three RCTs and five nRCTs) were included in the review. RCTs indicated a significant benefit of elemental nutrition vs. no intervention (an unrestricted diet) in maintaining remission at 24 months [one RCT; RR 2.06, 95% confidence interval (CI) 1.00 to 4.43; very low-grade evidence] and preventing relapse at 12–24 months post baseline (two RCTs; pooled RR 0.57, 95% CI 0.38 to 0.84;I2 = 0%; high-grade evidence). Similarly, three nRCTs showed significant benefits of elemental nutrition over no intervention in maintaining remission at 12–48 months and preventing relapse at 12 months post baseline (MD 1.20 months, 95% CI 0.35 to 2.04 months). The incidence of mucosal healing was not significantly different in the intervention and control groups (RR 2.70, 95% CI 0.62 to 11.72). Adherence to an elemental nutrition regime was significantly worse than adherence to polymeric nutrition (RR 0.68, 95% CI 0.50 to 0.92) and, when compared with other active treatments (medications, polymeric nutrition or a combination), elemental nutrition yielded non-significant results with wide 95% CIs, rendering these results inconclusive. Complications and adverse events were too sparse to allow meaningful comparisons. None of the studies reported cost-effectiveness of elemental nutrition. Owing to scarcity of data, subgroup and sensitivity analyses could not be performed to explore methodological and clinical sources of heterogeneity.LimitationsThe findings warrant cautious interpretation given the limitations of the evidence in methodological quality (small samples, short follow-up) and the RoB in individual studies (lack of blinding, confounding).ConclusionsLimited evidence indicates potential benefits of elemental nutrition against no intervention in the maintenance of remission and prevention of relapse in adult patients with CD. There was a lack or insufficient evidence on adverse events and complications. Future large and long-term randomised trials are warranted to draw more definitive conclusions regarding the effects of elemental nutrition in maintaining remission in CD.Trial registrationThis study is registered as PROSPERO CRD42013005134.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Randomised Controlled Trialsmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

“…The study and participant characteristics of the three included RCTs 50,52,55 are summarised in Table 1. Of three RCTs, two were conducted in Japan 50,52 and one in the UK.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

Section: Randomised Controlled Trialsmentioning

confidence: 99%

Section: Randomised Controlled Trialsmentioning

confidence: 99%

See 3 more Smart Citations

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Tsertsvadze

Gurung

Court

et al. 2015

Health Technology Assessment

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Enteral nutrition for maintenance of remission in Crohn's disease

Akobeng

Zhang

Gordon

et al. 2018

Cochrane Database of Systematic Reviews

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When is enteral nutrition indicated?

Bechtold

Brown

Escuro

et al. 2022

J Parenter Enteral Nutr

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Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence‐based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.

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Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn's disease

Cited by 63 publications

References 30 publications

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Enteral nutrition for maintenance of remission in Crohn's disease

When is enteral nutrition indicated?

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