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High Body Mass Index and Response to Anti-Tumor Necrosis Factor Therapy in Pediatric Crohn's Disease

Dawn R Ebach1, Traci W Jester2, Joseph A Galanko3

  • 1Division of Gastroenterology, Hepatology, Pancreatology, and Nutrition, University of Iowa, Iowa City, Iowa, USA.

The American Journal of Gastroenterology
|March 6, 2024
PubMed

Insights

High body mass index (BMI) in pediatric Crohn's disease (PCD) patients is linked to treatment failure with adalimumab (ADA), but not infliximab (IFX). Overweight children may need higher ADA doses due to lower drug levels.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Pharmacokinetics

Background:

  • Obesity is prevalent in pediatric Crohn's disease (PCD).
  • Adult studies suggest reduced anti-tumor necrosis factor (TNF) treatment efficacy in obese patients.
  • The impact of high body mass index (BMI) on anti-TNF therapy in PCD requires further investigation.

Purpose of the Study:

  • To compare anti-TNF treatment response and drug levels between pediatric patients with normal and high BMI.
  • To analyze the association between BMI and treatment failure in PCD patients receiving anti-TNF agents.

Main Methods:

  • Secondary analysis of the COMBINE trial data.
  • Compared time-to-treatment failure in normal BMI vs. high BMI (BMI Z-score >1) pediatric patients.
  • Adjusted for anti-TNF agent (infliximab [IFX] or adalimumab [ADA]), treatment assignment, and covariates.
  • Examined median anti-TNF levels across BMI categories.

Main Results:

  • High BMI was associated with increased ADA treatment failure (70% vs. 23%, P = 0.007).
  • ADA trough levels were lower in high BMI patients compared to normal BMI patients (5.8 vs. 12.8 microg/mL, P = 0.02).
  • No significant difference in IFX treatment failure or trough levels was observed between BMI groups.

Conclusions:

  • Overweight and obese pediatric patients with Crohn's disease are more likely to experience adalimumab treatment failure.
  • Higher BMI correlates with lower adalimumab drug trough levels, suggesting standard dosing may be insufficient.
  • Infliximab outcomes and drug levels were not affected by BMI, possibly due to weight-based dosing or monitoring.
Abstract

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