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Patients with Crohn's Disease with High Body Mass Index Present More Frequent and Rapid Loss of Response to Infliximab

Guerbau, Loic MD*; Gerard, Romain MD*; Duveau, Nicolas MD*; Staumont-Sallé, Delphine MD, PhD; Branche, Julien MD*; Maunoury, Vincent MD, PhD*; Cattan, Stéphane MD*; Wils, Pauline MD*; Boualit, Medina MD*; Libier, Louise MD*; Cotteau-Leroy, Angélique PharmD; Desreumaux, Pierre MD, PhD*; Nachury, Maria MD*; Pariente, Benjamin MD, PhD*

doi: 10.1097/MIB.0000000000001179
Original Clinical Articles

Background: Infliximab (IFX) is effective in inducing and maintaining remission in patients with luminal and anoperineal Crohn's disease (CD). However, treatment failure within 12 months after initiating IFX is observed in a significant proportion of patients. The aim of the present study was to determine whether the body mass index (BMI) affects response to IFX during the first year of treatment in patients with CD.

Methods: All patients with luminal CD who began IFX between January 2010 and May 2014 were prospectively included. BMI was calculated before IFX treatment was begun, and patients were divided into 3 groups: normal BMI (BMI < 25 kg/m2), overweight patients (BMI of 25.0–30 kg/m2), and obese patients (BMI > 30.0 kg/m2). The primary outcome was to evaluate the rate and delay of IFX optimization during the first year of treatment among normal weight, overweight, and obese patients.

Results: One hundred forty patients were included. Demographic and clinical characteristics at IFX initiation were comparable among the 3 groups. Within 12 months after the initiation of IFX, the rate of IFX optimization was significantly higher in overweight and obese patients than in the normal BMI group: 52%, 56%, and 20%, respectively (P = 0.0002). The median time until optimization of IFX was significantly shorter in overweight and obese patients than in the normal BMI group: 7, 7, and 10 months, respectively (P = 0.03). A BMI >25 kg/m2 was significantly associated with IFX optimization within 12 months on multivariate analysis.

Conclusion: This is the first study to show that optimization of IFX is more frequent and faster in obese and overweight patients with CD and occurs within 12 months after beginning IFX, suggesting that an induction regimen with higher doses of IFX and a tight control of IFX concentrations may be needed in these patients.

Article first published online 22 August 2017.Supplemental Digital Content is Available in the Text.

*CHU Lille, Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France;

CHU Lille, Dermatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France; and

CHU Lille, Pharmacy Department, Claude Huriez Hospital, University of Lille 2, Lille, France.

Address correspondence to: Benjamin Pariente, MD, PhD, Service des maladies de l'appareil digestif, Centre hospitalier Claude Huriez, 2 Avenue Oscar Lambret, 59000 Lille, France (e-mail: benjamin.pariente@chru-lille.fr).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

R. Gerard received travel accommodations from MSD and Hospira; P. Wils received travel accommodations from Biogaran and Janssen; M. Boualit received speaker fees from MSD, Abbvie, Takeda, and Hospira; P. Desreumeaux received speaker fees from Ferring, Shire Pharmaceuticals, UCB Phama, MSD, Norgne, Abbvie, and Pileje, and received consulting fees from Biofortis, Ferring, Giuliani SpA, Roquette, UCB Pharma, Txcell, Lesaffre, Abbvie, MSD, Norgine, Genfit, OmegaPharma International, Ppm, Kitozyme, LFB, Takeda, Boehringer Ingelheim, Intralytix, and Janssen; M. Nachury received speaker fees from Abbvie, MSD, Janssen, Takeda, Pfizer, and Ferring; B. Pariente received consulting fees from AbbVie, Takeda, MSD, Biogram, and Janssen, and received speaker fees from AbbVie, MSD, Ferring, Pfizer, Janssen, and Takeda. The other authors have no conflict of interest to disclose.

Received February 14, 2017

Accepted May 01, 2017

© Crohn's & Colitis Foundation
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