Faculty Collaboration Database

Patients With Inflammatory Bowel Diseases and Higher Visceral Adipose Tissue Burden May Benefit From Higher Infliximab Concentrations to Achieve Remission. Am J Gastroenterol 2023 Nov 01;118(11):2005-2013

Date

05/19/2023

Pubmed ID

37207314

Pubmed Central ID

PMC10720850

DOI

10.14309/ajg.0000000000002330

Scopus ID

2-s2.0-85175376052 (requires institutional sign-in at Scopus site)   5 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 μg/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.

Author List

Yarur AJ, Abreu MT, Deepak P, Beniwal-Patel P, Papamichael K, Vaughn B, Bruss A, Sekhri S, Moosreiner A, Gu P, Kennedy W, Dubinsky M, Cheifetz A, Melmed GY

Author

Poonam Beniwal-Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cross-Sectional Studies
Gastrointestinal Agents
Humans
Inflammatory Bowel Diseases
Infliximab
Intra-Abdominal Fat
Prospective Studies
Remission Induction