Mesenteric Adipose Tissue Volume Predicts Response to Antitumor Necrosis Factor Therapy in Biological-Naïve Patients...

Crohn's disease is associated with varying degrees of mesenteric adipose tissue (MAT) hypertrophy. The study aimed to evaluate whether MAT hypertrophy, measured by MAT volume, is associated with worse response to anti-tumor necrosis factor alpha (TNF-α) therapy in biologic-naïve patients with Crohn's disease (CD).

A cohort of consecutive patients with CD who underwent computed tomography or MRI before the start of the anti-TNF-α therapy was included. Total MAT volume, excluding large vessels, was estimated. Primary outcomes-dose intensification, surgery, and withdrawal of anti-TNF-α therapy-were evaluated at 3 and 12 months after the initiation of treatment. We performed a multivariate logistic regression model to identify MAT volume as an independent risk factor of poor response to anti-TNF-α.

Fifty biologic-naïve, consecutive patients with CD were included. The median MAT volume was 559.5 cm 3 (IQR: 410.3-891.9). MAT volume was positively correlated with weight (ρ = 0.66, P < 0.001) and age (ρ = 0.5, P < 0.001). Multivariate regression model showed that higher MAT volume independently predicted a poor response to anti-TNF-α treatment, as indicated by a greater need for dose intensification of anti-TNF-α agents within 12 months (adjusted odds ratio [OR a ]: 1.36; 95% CI: 1.08-1.81; P = 0.016) and an increased risk of CD surgery within 3 months (OR a : 1.65; 95% CI: 1.08-3.05; P = 0.048).

MAT volume predicted an increased need for anti-TNF-α dose intensification and surgery in patients with biological-naïve Crohn's disease. MAT volume could be a valuable measure for identifying patients at risk of a poor anti-TNF-α response.