Body mass index does not influence loss of response to tumor necrosis factor inhibitors in Crohn's disease.

Abstract

Objectives: Moderate to severe Crohn's disease (CD) treatment was revolutionized by introducing anti-tumor necrosis factor (TNF) agents, which is still a cornerstone of the treatment. It is speculated that adipose tissue may influence treatment response, especially for non-weight-adjusted agents.

Patients and methods: Research comparing the effectiveness of anti-TNFs between eutrophic and overweight patients may impact clinical management. We performed a retrospective analysis of a CD patient database. The primary endpoint was loss of response (LOR) after 54 weeks with infliximab (IFX) and adalimumab (ADA) in patients with body mass index (BMI) < 25 and ≥ 25. Secondary endpoints were steroid-free remission and endoscopic remission rate.

Results:  179 CD patients were evaluated; 48.9% had LOR after 54 weeks of anti-TNF therapy. Fifty-four patients had a BMI ≥ 25, with 51 receiving IFX and 28 receiving ADA. The univariate analysis identified LOR in 56.5% of the patients with IFX and 34.9% in the ADA group (p=0.009). In the 54-week multivariate analysis, loss of response in the IFX group with BMI ≥ 25 had a relative risk of 1.04 [CI 0,60-1.80 (p=0.891)] compared to patients with BMI < 25. Being overweight or obese led to a risk of 1.50 for LOR for ADA at 54 week time point [CI 0,60-3,74 (p=0.0387)]. Clinical remission at 54 weeks was similar between BMI groups.

Conclusions: Being overweight did not influence the LOR to treatment when IFX and ADA were compared, nor did it affect clinical and endoscopic remission after 54 weeks.