The following is a summary of “Patients With Inflammatory Bowel Diseases and Higher Visceral Adipose Tissue Burden May Benefit From Higher Infliximab Concentrations to Achieve Remission,” published in the November 2023 issue of Gastroenterology by Yarur, et al.
Patients with inflammatory bowel diseases (IBDs) often exhibit lower responsiveness to infliximab, potentially linked to high visceral adipose tissue (VAT) burden and its impact on volume distribution or clearance. Variations in VAT may also contribute to the diverse target trough levels of infliximab associated with positive outcomes. For a study, researchers sought to investigate the potential association between VAT burden and infliximab cutoffs linked to efficacy in patients with IBD.
A prospective cross-sectional study was conducted on IBD patients undergoing maintenance infliximab therapy. Baseline body composition parameters (measured by Lunar iDXA), disease activity, infliximab trough levels, and biomarkers were collected. The primary outcome was steroid-free deep remission, and the secondary outcome was endoscopic remission within 8 weeks of infliximab level measurement.
A total of 142 patients were enrolled. The optimal trough levels of infliximab cutoffs associated with steroid-free deep remission and endoscopic remission were 3.9 mcg/mL for patients in the lowest 2 VAT % quartiles (<1.2%). For patients in the highest 2 VAT % quartiles, the optimal infliximab level cutoff associated with steroid-free deep remission was 15.3 mcg/mL. In multivariable analysis, only VAT % and infliximab level remained independently associated with steroid-free deep remission (odds ratio per % of VAT: 0.3 [95% CI: 0.17–0.64], P < 0.001, and odds ratio per μg/mL: 1.11 [95% CI: 1.05–1.19], P < 0.001).
The findings suggested that patients with higher visceral adipose tissue burden may derive greater benefit from achieving higher infliximab levels to attain remission.