Weight and BMI Patterns in Biological Based IBD Patients and Its Finacial Impact

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions associated with reduced quality of life and impaired productivity. Due to recurrent disease activity and progressive structural damage, IBD imposes a significant burden on both public and private healthcare systems.

The use of advanced therapies for moderate to severe IBD has provided substantial benefits in recent decades, including reductions in hospitalization and surgery rates. Anti-Tumor Necrosis Factor-alpha (anti-TNF-α) agents typically constitute the first line of advanced therapy for both CD and UC. However, between 10% and 40% of patients may not respond to treatment (primary non-responders), and approximately 12% may lose response over time, particularly with infliximab (IFX).

Several mechanisms may contribute to IFX treatment failure. Immunogenicity, where antibodies form against the monoclonal antibody, is a primary factor. Other factors affecting IFX clearance include overweight and obesity. Drug clearance is influenced by the volume of distribution, which depends on patient weight. Additionally, excess adipose tissue can alter the pharmacokinetics of anti-TNF agents and exert endocrine and immunological effects through the release of adipocytokines, potentially contributing to the pathogenesis of inflammatory conditions. Therefore, excessive body weight may partly explain IFX therapy failure in some cases.

Obesity appears to negatively affect the response to immunosuppressants and anti-TNF agents. However, studies examining the relationship between obesity, anti-TNF response, and autoimmune diseases have reported inconsistent results. For example, an analysis of three randomized controlled trials of IFX in dermatology and rheumatology found no statistically significant differences in response rates across BMI groups. In contrast, a prospective cohort study in patients with rheumatoid arthritis reported that obese patients treated with IFX had lower clinical response rates. A systematic review and meta-analysis found that obesity was associated with a 60% higher likelihood of losing response to anti-TNF agents compared to non-obese patients with rheumatoid arthritis, ankylosing spondylitis, and psoriasis. However, this association has not been confirmed in patients with IBD.

To date, few studies have examined the influence of obesity or overweight on endoscopic remission in IBD. In a recent cohort study of IFX-treated patients, Singh et al. (2018) found no significant reduction in mucosal healing in obese patients after adjusting for covariates (CI: 0.12-2.35; p=0.31). Other recent studies have demonstrated that body composition parameters, such as subcutaneous adiposity index, visceral adiposity index, and skeletal muscle mass index, are independent factors correlated with active Crohn's disease, with visceral adiposity negatively impacting disease activity.