Increases in body mass index during infliximab therapy in patients with Crohn's disease: an open label prospective study

In the past, the impact of infliximab therapy on nutritional status in patients with Crohn’s disease (CD) has not been assessed. This prospective study was to investigate the effect of infliximab on nutritional status in CD patients. Fifty consecutive patients with active CD received infliximab (5 mg/kg) at weeks 0, 2 and 6 as remission induction therapy, and then at 8 weeks intervals as maintenance therapy. Patients were followed for 60 weeks. CD activity index (CDAI) and body mass index (BMI) were monitored. A fall in CDAI by ?70 was defined as response to therapy, while CDAI <150 meant clinical remission. At week 10, 39 patients (78%) responded to infliximab induction therapy. BMI significantly increased during these 10 weeks (P < 0.0001). The mean increase in BMI was significantly higher in patients who responded to infliximab vs patients who did not (P = 0.03). Further, at weeks 30 and 60, 35 patients (70%) and 33 (66%) were in remission, respectively. The mean increase in BMI was significantly higher in patients who maintained remission vs patients not in remission (week 30, P = 0.02; week 60, P = 0.01). Patients with a low baseline BMI (<18.5) and those with small bowel involvement achieved a higher increase in BMI as compared to patients with BMI ?18.5 or patients without small bowel involvement. In this study, infliximab therapy was associated with improvement of patients’ nutritional status, notably patients who responded to this biologic. Additionally, in patients with malnutrition and small bowel involvement, the nutritional impact of infliximab was higher.