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World J Gastroenterol. Apr 14, 2007; 13(14): 2089-2093
Published online Apr 14, 2007. doi: 10.3748/wjg.v13.i14.2089
Crohn’s disease, fatigue, and infliximab: Is there a role for cytokines in the pathogenesis of fatigue?
Itta M Minderhoud, Melvin Samsom, Bas Oldenburg
Itta M Minderhoud, Melvin Samsom, Bas Oldenburg, Department of Gastroenterology, University Medical Centre Utrecht, The Netherlands
Author contributions: All authors contributed equally to the work.
Correspondence to: B Oldenburg, Department of Gastro-enterology, F02.618, PO box 85500, 3508 GA Utrecht, The Netherlands. b.oldenburg@umcutrecht.nl
Telephone: +31-30-2509662 Fax: +31-30-2505533
Received: January 26, 2007
Revised: February 10, 2007
Accepted: February 14, 2007
Published online: April 14, 2007
Abstract

AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn’s disease (CD) patients.

METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals.

RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points ± 1.1, P≤ 0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points ± 1.4, P≤ 0.05). Quality of life was increased at the end of the study compared to baseline values (138.6 ± 9.4 vs 179.4 ± 6.7; P≤ 0.005), whereas depression scores were decreased (20.4 ± 9.4 vs 11.3 ± 2.2; P≤ 0.01). No correlation between the severity of fatigue and the level of cytokines was observed.

CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.

Keywords: Crohn’s disease; Fatigue; Infliximab; Cytokines