P649 Crohn’s disease patients with high body mass index present more frequent and rapid loss of response to infliximab
L. Guerbau*, R. Gerard, N. Duveau, P. Desreumaux, M. Boualit, J. Branche, V. Maunoury, L. Libier, S. Cattan, C. Gower-Rousseau, A. Cotteau-Leroy, M. Nachury, B. Pariente
Centre Hospitalier Universitaire de Lille, Lille, France
Infliximab (IFX), a tumour necrosis factor (TNF) antagonist, is effective in patients with luminal and perianal Crohn’s disease (CD). Nevertheless, up to 40% of patients with an initial response to IFX lose the benefit within the first year. Excess of fat tissue may have pharmacological effects on TNF antagonists. The aim of our study was to determine whether the body mass index (BMI) affects response to IFX during the first year of treatment in CD patients.
We performed a retrospective and observational study at a tertiary referral centre, including all luminal CD patients who started IFX between January 2009 and May 2014. BMI was calculated before initiation of IFX, and patients were divided into 3 groups according to the WHO BMI categories: BMI < 25 kg/m2 (normal BMI); 25 kg/m2 ≤ BMI ≤ 30 kg/m2 (overweight); and BMI > 30 kg/m2 (obesity). The following data were recorded during the first year of follow-up: optimisation of IFX treatment, delay of IFX optimisation, rate of mucosal and/or morphological healing, occurrence of an intestinal resection surgery, introduction of corticosteroid (CT) and/or immunosuppressant (IS) therapy, and IFX treatment withdrawal. The occurrence of 1 of the 3 previous events (occurrence of surgery, CT or IS introduction, and IFX withdrawal) was considered as a pejorative event.
In total, 140 patients were included, with 96 (69%) patients with normal BMI, 21 (15%) overweight patients, and 23 (16%) obese patients. Median BMI at baseline was 23.4 kg/m2. Baseline demographic and clinical characteristics were not significantly different amongst the 3 groups of patients (including disease location and behaviour, disease activity, C-reactive protein, and concomitant IS therapy at time of IFX introduction). At 12 months after IFX introduction, rate of IFX optimisation was significantly higher in overweight and obese patients compared with patients with normal BMI patients: 48%, 44%, and 20%, respectively (p = 0.0002). Further, median delay of IFX optimisation was significantly shorter in overweight and obese patients compared with patients with normal BMI: 8.5, 8, and 17 months, respectively (p = 0.03). No significant difference was observed amongst overweight and obese patients regarding rate and delay of IFX optimisation (p = 1.0000 and p = 0.93, respectively). No difference was observed amongst the 3 groups of patients concerning the others studied parameters.
We here report the first study demonstrating a more frequent and more rapid loss of response to IFX treatment in overweight and obese CD patients. These results suggest that these patients might receive induction regimen with higher doses of IFX and tight control of trough level IFX measurements.