Scand J Immunol. 2024 Dec;100(6):e13409. doi: 10.1111/sji.13409.Epub 2024 Oct 2.

Laura Gregersen ^1 2, Pernille Dyhre Jessen ^1 2, Helene Wiencke Lund ^1 2, Silja Hvid Overgaard ^1 2, Zainab Hikmat ^1 2, Torkell Ellingsen ³, Jens Kjeldsen ⁴, Andreas Kristian Pedersen ^5 6, Sofie Ronja Petersen ⁵, Mohamad Jawhara ⁷, Anders Bathum Nexøe ², Anette Bygum ⁸, Christian Lodberg Hvas ^9 10, Jens Frederik Dahlerup ^10 11, Frederik Olof Bergenheim ¹¹, Henning Glerup ¹², Rikke Holm Henriksen ¹², Tanja Guldmann ¹², Lone Hvid ¹³, Jacob Brodersen ^2 14, Heidi Lausten Munk ^15 16, Natalia Pedersen ¹⁷, Sanaz Saboori ¹⁷, Ole Haagen Nielsen ¹⁸, Berit Lillenthal Heitmann ¹⁹, Thorhallur Ingi Haldorsson ^1 20, Robin Christensen ^3 21, Vibeke Andersen ^6 22

Author information

¹Molecular Diagnostics and Clinical Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark.

²The Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.

³Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.

⁴Research Unit of Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.

⁵Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark.

⁶Open Patient Data Exploration Network (OPEN), Odense, Denmark.

⁷Section of Upper Benign and Hernia Surgery (G3), Department of Surgery, Odense University Hospital, Svendborg, Denmark.

⁸Research Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.

⁹Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.

¹⁰Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

¹¹The Abdominal Center, Medical Section, Bispebjerg University Hospital, Copenhagen, Denmark.

¹²University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.

¹³Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.

¹⁴Department of Internal Medicine-Gastroenterology, Esbjerg & Grindsted Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark.

¹⁵Department of Rheumatology, Odense University Hospital, Odense, Denmark.

¹⁶Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.

¹⁷Department of Gastroenterology, Slagelse Regional Hospital, Slagelse, Denmark.

¹⁸Department of Gastroenterology, Herlev Hospital, Herlev, Denmark.

¹⁹Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

²⁰Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.

²¹Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

²²Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.

Abstract

Chronic inflammatory diseases (CIDs) pose a growing healthcare challenge, with a substantial proportion of patients showing inadequate response to biological treatment. There is renewed interest in dietary changes to optimize treatment regimens, with a growing body of evidence suggesting beneficial effects with adherence to a gluten-free diet. This study compared the likelihood of achieving clinical response to biological treatment after 14-16 weeks in patients with CID with high versus low-to-medium gluten intake. Secondary outcomes of interest included changes in disease activity, health-related quality of life and C-reactive protein. The study was a multicentre prospective cohort of 193 participants with a CID diagnosis (i.e. Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis, Axial Spondyloarthritis, Psoriatic Arthritis or Psoriasis) who initiated biological treatment between 2017 and 2020. Participants were stratified based on their habitual gluten intake: the upper 33.3% (high gluten intake) and the remaining 66.6% (low-to-medium gluten intake). The proportion of patients achieving clinical response to biological treatment after 14-16 weeks was compared using logistic regression models. The median gluten intake differed significantly between groups (12.5 g/day vs. 5.9 g/day, standardized mean difference = 1.399). In total, 108 (56%) achieved clinical response to treatment, with no difference between 35 (55%) in the high gluten group and 73 (57%) in the medium-to-low gluten group (OR = 0.96 [0.51-1.79], p = 0.897). No differences were found with secondary outcomes. In conclusion, this study found no association between gluten intake and response to biological treatment in patients with CID.