P345 Rapid weight increase in Infliximab treated Crohn's disease patients is sustained over time
J. Lepp*, A. Forsell, U. Fyrhake, M. Lördal, S. Almer
Karolinska Institutet, Department of Medicine and GastroCentrum, Karolinska university hospital, Stockholm, Sweden
Infliximab (IFX) is used in moderate to severe Crohn's disease and is effective for induction and maintenance of remission. There are scanty systematic data on weight gain and metabolic changes in IBD-patients under anti-TNF treatment. We have noticed that some, but not all, patients increase their body weight during treatment with IFX. Here we investigated changes in weight and blood chemistry in anti-TNF-naïve patients during their first course of IFX.
Retrospective analysis of 70 patients (51 men, 19 women) aged 24 years (range 14-33), 42 with luminal CD and 28 with fistulising CD, given at least 3 infusions of IFX (range 3-11). Data regarding body weight, height, C-reactive protein (CRP), haemoglobin and S-albumin before treatment and before the third infusion and at 1 year were collected from the medical records. Of statistical Methods, descriptive statistics, student´s T-test and Pearson´s correlation analysis have been used.
At 6 weeks, 46 (66 %) increased in weight, 18 patients decreased in weight, and 6 had no change. Overall, there was a significant increase in weight (2 kg, IQR=-1-3 kg) and BMI at 6 weeks of treatment (P<0.001 and P<0.001 respectively). Patients with normal BMI at start of treatment had a larger weight gain compared to obese patients (p<0.05). CRP significantly decreased and albumin and haemoglobin increased (P<0,001). The weight gain at 6 weeks correlated to the increase in haemoglobin as well as a decrease in CRP (both P<0.01). There was no difference between men and women.
At 12 months: 57 patients continued IFX treatment for at least one year. Compared to baseline, 39 (68 %) patients had increased in weight, 16 patients decreased weight, 2 had no change. Overall, compared to baseline values treatment was associated with a significant increase in weight (3 kg, IQR=-1-7 kg) and BMI (p<0.001 and p<0.001, respectively). Increased weight correlated with decrease in CRP and increase in albumin and haemoglobin (P<0.001, P<0.01 and P<0.05, respectively). Patients treated with glucocorticosteroids during the induction phase had a larger increase in weight and BMI compared to those without glucocorticosteroids (P<0.04 and P<0.05, respectively). Again, there was no difference between men and women.
Approximately 70 % of infliximab treated Crohn's disease patients experience weight gain within the first 6 weeks. The weight increment correlates with improvements in inflammatory markers. The causes of the weight gain needs to be further explored, and, is probably related to reduction of the inflammatory burden as well as to treatment induced metabolic changes.