Does Weight-Adjusted Anti-Tumour Necrosis Factor Treatment Favour Obese Patients With Crohn's Disease?

Eur J Gastroenterol Hepatol. 2013 May;25(5):543-9. doi: 10.1097/MEG.0b013e32835d1f15.

Abstract

Background: Adalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn's disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response.

Aim: To determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable.

Materials and methods: A hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan-Meier (KM) survival curves and a Cox proportional hazards model.

Results: ADA patients: Of the 54 patients (46 BMI<30 and 8 BMI≥30), KM estimation indicated a significantly shorter time to dose escalation in the BMI of at least 30 (χ=6.117, P=0.01). The Cox proportional hazards model showed that an increased hazard of LOR to ADA is related to increases in BMI (P=0.04). IFX patients: Of the 76 patients (62 BMI<30 and 14 BMI≥30), KM estimation showed that the differences in survival curves were not significant (χ=1.933, P=0.16) for the BMI groups. This was supported by the Cox proportional hazard model (P=0.36).

Conclusion: BMI appears to be important in predicting ADA efficacy (LOR) in CD. IFX appears to overcome this reduction of efficacy in obese patients. A prospective study evaluating the effect of weight on anti-TNF drug response and serum drug levels is warranted.

MeSH terms

  • Adalimumab
  • Adolescent
  • Adult
  • Aged
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Body Mass Index
  • Body Weight / physiology
  • Crohn Disease / complications
  • Crohn Disease / drug therapy*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Tolerance / physiology
  • Female
  • Gastrointestinal Agents / administration & dosage*
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Infliximab
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology
  • Retrospective Studies
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Gastrointestinal Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab