An increase in the proportion of visceral adipose tissue in patients with inflammatory bowel diseases reduces the effectiveness of infliximab treatment when using the drug in usual doses. To achieve remission, such patients need to increase the dose of the drug.
Researchers from Cedars-Sinai Medical Center in Los Angeles, the Medical College of Wisconsin, and the University of Miami examined the association of visceral adipose tissue volume with decreased efficacy of infliximab in patients with inflammatory bowel disease. The study results were published in the journal AJG.
The optimal minimum threshold level of infliximab associated with achieving durable remission without the need for steroid therapy and endoscopic remission in patients with a visceral adipose tissue fraction of less than 1.2% was 3.9 μg/ml. However, the minimum infliximab concentration associated with sustained remission without the need for corticosteroid therapy in patients with a higher proportion of visceral adipose tissue was 15.3 μg/mL. This is almost four times higher than drug concentrations in patients with a lower proportion of visceral adipose tissue.
|Data from 142 patients with inflammatory bowel disease who received maintenance therapy with infliximab were analyzed. Efficacy analyzes included body composition (assessed using a Lunar iDXA densitometer), disease activity, trough drug concentrations, and biomarkers. The rate of sustained remission without the need for steroid therapy and endoscopic remission within 8 weeks after measuring infliximab concentrations was assessed.
Researchers believe that to achieve remission of inflammatory bowel disease, patients with an increased proportion of visceral adipose tissue need increased doses of infliximab.