Patients With Inflammatory Bowel Diseases and Higher Visceral Adipose Tissue Burden May Benefit From Higher Infliximab Concentrations to Achieve Remission

Andres J. Yarur, Maria T. Abreu, Parakkal Deepak, Poonam Beniwal-Patel, Konstantinos Papamichael, Byron Vaughn, Alexandra Bruss, Shaina Sekhri, Andrea Moosreiner, Phillip Gu, William Kennedy, Marla Dubinsky, Adam Cheifetz, Gil Y. Melmed

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

INTRODUCTION: In patients with inflammatory bowel diseases (IBDs), high visceral adipose tissue (VAT) burden is associated with a lower response to infliximab, potentially through alterations in volume distribution and/or clearance. Differences in VAT may also explain the heterogeneity in target trough levels of infliximab associated with favorable outcomes. The aim of this study was to assess whether VAT burden may be associated with infliximab cutoffs associated with efficacy in patients with IBD. METHODS: We conducted a prospective cross-sectional study of patients with IBD receiving maintenance infliximab therapy. We measured baseline body composition parameters (Lunar iDXA), disease activity, trough levels of infliximab, and biomarkers. The primary outcome was steroid-free deep remission. The secondary outcome was endoscopic remission within 8 weeks of infliximab level measurement. RESULTS: Overall, 142 patients were enrolled. The optimal trough levels of infliximab cutoffs associated with steroid-free deep remission and endoscopic remission were 3.9 mcg/mL (Youden Index [J]: 0.52) for patients in the lowest 2 VAT % quartiles (<1.2%) while optimal infliximab level cutoffs associated with steroid-free deep remission for those patients in the highest 2 VAT % quartiles was 15.3 mcg/mL (J: 0.63). In a multivariable analysis, only VAT % and infliximab level remained independently associated with steroid-free deep remission (odds ratio per % of VAT: 0.3 [95% confidence interval: 0.17–0.64], P < 0.001 and odds ratio per mg/mL: 1.11 [95% confidence interval: 1.05–1.19], P < 0.001). DISCUSSION: The results may suggest that patients with higher visceral adipose tissue burden may benefit from achieving higher infliximab levels to achieve remission.

Original languageEnglish
Pages (from-to)2005-2013
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume118
Issue number11
DOIs
StatePublished - Nov 1 2023

Keywords

  • Crohn’s disease
  • Infliximab
  • anti-infliximab antibodies
  • obesity
  • outcomes
  • remission
  • therapeutic drug monitoring
  • ulcerative colitis
  • visceral adipose tissue

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