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P367 Weight patterns in biologicals treated Inflammatory bowel disease cohort

Kaazan, P.(1,2);Tan , Z.(3);Maiyani, P.(1);Mickenbecker, M.(1);Edwards, S.(2);McIvor, C.(1);Andrews , J.M.(3);

(1)Logan Hospital, Gastroenterology and Hepatology, Brisbane, Australia;(2)The University of Adelaide, Medical sciences, Adelaide, Australia;(3)Royal Adelaide Hospital, Gastroenterology and Hepatology, Adelaide, Australia; NA

Background

Biologic therapies are effective at inducing and maintaining remission in patients with inflammatory bowel disease (IBD). Previous studies have associated TNF-a inhibitors with weight gain, however it is unclear if this is a class-related effect or a manifestation of clinical remission. We performed this retrospective study to compare weight changes from baseline across different biological classes, examine weight patterns over time and assess characteristics and associations within each (sub)groups.

Methods

Adult patients with IBD who received any biological therapy for at least 12 months, between 2008 and 2020, were identified from prospectively maintained records at two IBD units in Australia. Data collected included demographics; weight and BMI at baseline, 6, 12, 24 and 48 months; IBD type and phenotype; baseline endoscopy, baseline haemoglobin, C-reactive protein (CRP) and albumin; combination or monotherapy; initial steroid therapy and frequency of biologic infusion. Patients with missing data were excluded.

A linear mixed-effects model was performed for the outcome of weight change from baseline, including the interaction of treatment group and time period. A latent class analysis was then performed, assigning patients to weight trajectory groups, and univariate ordinal logistic regressions were used to explore possible associations between membership of each group (the outcome) against various predictive factors.

Results

Of 294 patients (156 females), 165 received Infliximab (IFX), 68 Adalimumab (ADA), 36 Vedolizumab (VDZ) and 25 Ustekinumab (UST). There was a statistically significant interaction between time and treatment group with a significant weight gain over time in both the IFX and VDZ groups. After adjusting for baseline weight and inflammatory markers, significant weight gain was found for IFX vs ADA and VDZ vs ADA at most time points (Fig.1). Significantly less weight gain was seen in those with a higher initiation weight. Each 10kg increase in baseline weight resulted in 0.5kg less weight gain. This effect also held true for BMI.

Latent class analysis identified three weight trajectories: 57.4% of patients had small weight loss (-2.3kg), 37.8% small weight gain (6.6 kg) and 4.8% large weight gain (24.3 kg). Baseline BMI inversely influenced weight gain; with every 1 unit increase in BMI, reducing the odds of large weight gain by 8%. Being female, having an initiation CRP£5 or albumin>35 also reduced the odds of large weight gain.

Conclusion

Weight gain in biological-treated IBD patients appears to be associated with male gender, active baseline inflammation and the type of drug used. 

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