Treatment Failure of TNF-α Inhibitors in Obese Patients With Inflammatory Bowel Disease-A Cohort Study

Kenneth Grønkjær Madsen, Anton Pottegård, Jesper Hallas, Jens Kjeldsen

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Abstract

Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti-TNF-α agents, compared with normal weight IBD patients.

Methods: We identified a cohort of adult IBD patients treated with anti-TNF-α agents at a Danish university hospital. Patients were grouped according to body mass index (BMI), and our main outcome was time to LOR. We performed survival analyses on LOR and calculated hazard ratios (HRs) with the normal weight group as the reference, while adjusting for confounders.

Results: Of 210 eligible patients, 92 (44%) experienced LOR. One hundred eighty patients were treated with infliximab and 30 with adalimumab, 114 (54%) were normal weight, 51 (24%) were overweight, and 45 (21%) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95% confidence interval [CI], 0.51-1.56) and obese 1.31 (95% CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR. Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95% CI, 1.03-5.70).

Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR.

Original languageEnglish
JournalInflammatory Bowel Diseases
Volume24
Issue number12
Pages (from-to)2628–2633
ISSN1078-0998
DOIs
Publication statusPublished - 29. Nov 2018

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Treatment Failure
Inflammatory Bowel Diseases
Cohort Studies
Tumor Necrosis Factor-alpha
Weights and Measures
Body Mass Index
Confidence Intervals
Survival Analysis
Ulcerative Colitis
Regression Analysis

Keywords

  • Anti-tumor necrosis factor-α agents
  • Crohn's disease
  • IBD
  • Obesity
  • Ulcerative colitis

Cite this

@article{650d8a128ae64e5bb2e9cc75890fdff1,
title = "Treatment Failure of TNF-α Inhibitors in Obese Patients With Inflammatory Bowel Disease-A Cohort Study",
abstract = "Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti-TNF-α agents, compared with normal weight IBD patients.Methods: We identified a cohort of adult IBD patients treated with anti-TNF-α agents at a Danish university hospital. Patients were grouped according to body mass index (BMI), and our main outcome was time to LOR. We performed survival analyses on LOR and calculated hazard ratios (HRs) with the normal weight group as the reference, while adjusting for confounders.Results: Of 210 eligible patients, 92 (44{\%}) experienced LOR. One hundred eighty patients were treated with infliximab and 30 with adalimumab, 114 (54{\%}) were normal weight, 51 (24{\%}) were overweight, and 45 (21{\%}) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95{\%} confidence interval [CI], 0.51-1.56) and obese 1.31 (95{\%} CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR. Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95{\%} CI, 1.03-5.70).Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR.",
keywords = "Anti-tumor necrosis factor-α agents, Crohn's disease, IBD, Obesity, Ulcerative colitis",
author = "Madsen, {Kenneth Gr{\o}nkj{\ae}r} and Anton Potteg{\aa}rd and Jesper Hallas and Jens Kjeldsen",
year = "2018",
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}

Treatment Failure of TNF-α Inhibitors in Obese Patients With Inflammatory Bowel Disease-A Cohort Study. / Madsen, Kenneth Grønkjær; Pottegård, Anton; Hallas, Jesper; Kjeldsen, Jens.

In: Inflammatory Bowel Diseases, Vol. 24, No. 12, 29.11.2018, p. 2628–2633.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Treatment Failure of TNF-α Inhibitors in Obese Patients With Inflammatory Bowel Disease-A Cohort Study

AU - Madsen, Kenneth Grønkjær

AU - Pottegård, Anton

AU - Hallas, Jesper

AU - Kjeldsen, Jens

PY - 2018/11/29

Y1 - 2018/11/29

N2 - Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti-TNF-α agents, compared with normal weight IBD patients.Methods: We identified a cohort of adult IBD patients treated with anti-TNF-α agents at a Danish university hospital. Patients were grouped according to body mass index (BMI), and our main outcome was time to LOR. We performed survival analyses on LOR and calculated hazard ratios (HRs) with the normal weight group as the reference, while adjusting for confounders.Results: Of 210 eligible patients, 92 (44%) experienced LOR. One hundred eighty patients were treated with infliximab and 30 with adalimumab, 114 (54%) were normal weight, 51 (24%) were overweight, and 45 (21%) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95% confidence interval [CI], 0.51-1.56) and obese 1.31 (95% CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR. Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95% CI, 1.03-5.70).Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR.

AB - Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti-TNF-α agents, compared with normal weight IBD patients.Methods: We identified a cohort of adult IBD patients treated with anti-TNF-α agents at a Danish university hospital. Patients were grouped according to body mass index (BMI), and our main outcome was time to LOR. We performed survival analyses on LOR and calculated hazard ratios (HRs) with the normal weight group as the reference, while adjusting for confounders.Results: Of 210 eligible patients, 92 (44%) experienced LOR. One hundred eighty patients were treated with infliximab and 30 with adalimumab, 114 (54%) were normal weight, 51 (24%) were overweight, and 45 (21%) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95% confidence interval [CI], 0.51-1.56) and obese 1.31 (95% CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR. Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95% CI, 1.03-5.70).Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR.

KW - Anti-tumor necrosis factor-α agents

KW - Crohn's disease

KW - IBD

KW - Obesity

KW - Ulcerative colitis

U2 - 10.1093/ibd/izy178

DO - 10.1093/ibd/izy178

M3 - Journal article

C2 - 29788214

VL - 24

SP - 2628

EP - 2633

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 12

ER -