High Body Mass Index and Response to Anti-TNF Therapy in Pediatric Crohn Disease

Dawn R Ebach; Traci W Jester; Joseph A Galanko; Ann M Firestine; Rana Ammoury; Jose Cabrera; Julie Bass; Phillip Minar; Kelly Olano; Peter Margolis; Kelly Sandberg; Tiffany M Linnville; Jess Kaplan; Lisa Pitch; Steven J Steiner; Dorsey Bass; Jonathan Moses; Jeremy Adler; Ajay S Gulati; Prateek Wali; Dinesh Pashankar; Anastasia Ivanova; Hans Herfarth; David A Wohl; Keith J Benkov; Jennifer Strople; Jillian Sullivan; Jeanne Tung; Zorela Molle-Rios; Shehzad A Saeed; Athos Bousvaros; Michael D Kappelman

doi:10.14309/ajg.0000000000002741

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High Body Mass Index and Response to Anti-TNF Therapy in Pediatric Crohn Disease

Journal article

Peer reviewed

High Body Mass Index and Response to Anti-TNF Therapy in Pediatric Crohn Disease

Dawn R Ebach, Traci W Jester, Joseph A Galanko, Ann M Firestine, Rana Ammoury, Jose Cabrera, Julie Bass, Phillip Minar, Kelly Olano, Peter Margolis, …

The American journal of gastroenterology, Vol.119(6), pp.1110-1116

06/2024

DOI: 10.14309/ajg.0000000000002741

PMCID: PMC11150092

PMID: 38445644

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Abstract

Obesity is common among patients with pediatric Crohn's disease (PCD). Some adult studies suggest obese patients respond less well to anti-TNF treatment. This study sought compares anti-TNF response and anti-TNF levels between pediatric patients with normal and high body mass index (BMI). The COMBINE trial compared anti-TNF monotherapy to combination therapy with methotrexate in patients with PCD. In this secondary analysis, a comparison of time-to-treatment failure among patients with normal BMI versus BMI Z score > 1, adjusting for prescribed anti-TNF (infliximab or adalimumab), trial treatment assignment (combination versus monotherapy), and relevant covariates. Median anti-TNF levels across BMI category was also examined. Of 224 participants (162 infliximab initiators and 62 adalimumab initiators), 111 (81%) had a normal BMI and 43 (19%) had a high BMI. High BMI was associated with treatment failure among adalimumab initiators [7/10 (70%) vs 12/52 (23%), HR 0.29, p=.007] but not infliximab initiators. Additionally, adalimumab-treated patients with a high BMI had lower adalimumab levels compared to those with normal BMI (median 5.8 ug/mL vs 12.8 ug/mL, p=0.02). Infliximab trough levels did not differ between BMI groups. Overweight and obese patients with PCD are more likely to experience adalimumab treatment failure than those with normal BMI. Higher BMI was associated with lower drug trough levels. Standard adalimumab dosing may be insufficient for overweight children with PCD. Among infliximab initiators, there was no observed difference in clinical outcomes or drug levels, perhaps due to weight-based dosing and/or greater use of proactive drug monitoring.

Details

Title: Subtitle: High Body Mass Index and Response to Anti-TNF Therapy in Pediatric Crohn Disease
Creators: Dawn R Ebach - University of Iowa
Traci W Jester - University of Alabama at Birmingham
Joseph A Galanko - University of North Carolina at Chapel Hill
Ann M Firestine - University of North Carolina at Chapel Hill
Rana Ammoury - Children's Hospital of The King's Daughters
Jose Cabrera - Children's Hospital of Wisconsin
Julie Bass - Mercy Medical Center
Phillip Minar - Cincinnati Children's Hospital Medical Center
Kelly Olano - Cincinnati Children's Hospital Medical Center
Peter Margolis - Cincinnati Children's Hospital Medical Center
Kelly Sandberg - Wright State University
Tiffany M Linnville - Levine Children's Hospital
Jess Kaplan - Massachusetts General Hospital
Lisa Pitch - ImproveCareNow Parent Representative
Steven J Steiner - Riley Hospital for Children
Dorsey Bass - Stanford Medicine
Jonathan Moses - Stanford Medicine
Jeremy Adler - C. S. Mott Children's Hospital
Ajay S Gulati - University of North Carolina at Chapel Hill
Prateek Wali - SUNY Upstate Medical University
Dinesh Pashankar - Yale New Haven Hospital
Anastasia Ivanova - University of North Carolina at Chapel Hill
Hans Herfarth - University of North Carolina at Chapel Hill
David A Wohl - University of North Carolina at Chapel Hill
Keith J Benkov - Icahn School of Medicine at Mount Sinai
Jennifer Strople - Lurie Children's Hospital
Jillian Sullivan - University of Vermont Children’s Hospital
Jeanne Tung - University of Oklahoma
Zorela Molle-Rios - Nemours Children's Health System
Shehzad A Saeed - Wright State University
Athos Bousvaros - Boston Children's Hospital
Michael D Kappelman - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: The American journal of gastroenterology, Vol.119(6), pp.1110-1116
DOI: 10.14309/ajg.0000000000002741
PMID: 38445644
PMCID: PMC11150092
NLM abbreviation: Am J Gastroenterol
eISSN: 1572-0241
Grant note: PCS-1406-18643 / Patient-Centered Outcomes Research Institute U19ARD69525 / NIAMS NIH HHS
Language: English
Electronic publication date: 03/06/2024
Date published: 06/2024
Academic Unit: Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9984568048102771

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