Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn’s disease?
BACKGROUNDAdalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn’s disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response. AIMTo determine whether obe...
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| Veröffentlicht in: | European journal of gastroenterology & hepatology 2013-05, Vol.25 (5), p.543-549 |
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| container_title | European journal of gastroenterology & hepatology |
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| creator | Bhalme, Mahesh Sharma, Abhishek Keld, Richard Willert, Robert Campbell, Simon |
| description | BACKGROUNDAdalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn’s disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response.
AIMTo determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable.
MATERIALS AND METHODSA hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan–Meier (KM) survival curves and a Cox proportional hazards model.
RESULTSADA patientsOf the 54 patients (46 BMI |
| doi_str_mv | 10.1097/MEG.0b013e32835d1f15 |
| format | Article |
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AIMTo determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable.
MATERIALS AND METHODSA hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan–Meier (KM) survival curves and a Cox proportional hazards model.
RESULTSADA patientsOf the 54 patients (46 BMI<30 and 8 BMI≥30), KM estimation indicated a significantly shorter time to dose escalation in the BMI of at least 30 (χ=6.117, P=0.01). The Cox proportional hazards model showed that an increased hazard of LOR to ADA is related to increases in BMI (P=0.04). IFX patientsOf the 76 patients (62 BMI<30 and 14 BMI≥30), KM estimation showed that the differences in survival curves were not significant (χ=1.933, P=0.16) for the BMI groups. This was supported by the Cox proportional hazard model (P=0.36).
CONCLUSIONBMI appears to be important in predicting ADA efficacy (LOR) in CD. IFX appears to overcome this reduction of efficacy in obese patients. A prospective study evaluating the effect of weight on anti-TNF drug response and serum drug levels is warranted.</description><identifier>ISSN: 0954-691X</identifier><identifier>EISSN: 1473-5687</identifier><identifier>DOI: 10.1097/MEG.0b013e32835d1f15</identifier><identifier>PMID: 23337170</identifier><language>eng</language><publisher>England: Lippincott Williams & Wilkins, Inc</publisher><subject>Adalimumab ; Adolescent ; Adult ; Aged ; Antibodies, Monoclonal - administration & dosage ; Antibodies, Monoclonal - therapeutic use ; Antibodies, Monoclonal, Humanized - administration & dosage ; Antibodies, Monoclonal, Humanized - therapeutic use ; Body Mass Index ; Body Weight - physiology ; Crohn Disease - complications ; Crohn Disease - drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Tolerance - physiology ; Female ; Gastrointestinal Agents - administration & dosage ; Gastrointestinal Agents - therapeutic use ; Humans ; Infliximab ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Obesity - complications ; Obesity - physiopathology ; Retrospective Studies ; Treatment Outcome ; Tumor Necrosis Factor-alpha - antagonists & inhibitors ; Young Adult</subject><ispartof>European journal of gastroenterology & hepatology, 2013-05, Vol.25 (5), p.543-549</ispartof><rights>2013 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3565-46ce2acd3001151a626b8a37c5696216c6d2b9b1159d3218d3e7c5384e4d08a63</citedby><cites>FETCH-LOGICAL-c3565-46ce2acd3001151a626b8a37c5696216c6d2b9b1159d3218d3e7c5384e4d08a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23337170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhalme, Mahesh</creatorcontrib><creatorcontrib>Sharma, Abhishek</creatorcontrib><creatorcontrib>Keld, Richard</creatorcontrib><creatorcontrib>Willert, Robert</creatorcontrib><creatorcontrib>Campbell, Simon</creatorcontrib><title>Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn’s disease?</title><title>European journal of gastroenterology & hepatology</title><addtitle>Eur J Gastroenterol Hepatol</addtitle><description>BACKGROUNDAdalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn’s disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response.
AIMTo determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable.
MATERIALS AND METHODSA hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan–Meier (KM) survival curves and a Cox proportional hazards model.
RESULTSADA patientsOf the 54 patients (46 BMI<30 and 8 BMI≥30), KM estimation indicated a significantly shorter time to dose escalation in the BMI of at least 30 (χ=6.117, P=0.01). The Cox proportional hazards model showed that an increased hazard of LOR to ADA is related to increases in BMI (P=0.04). IFX patientsOf the 76 patients (62 BMI<30 and 14 BMI≥30), KM estimation showed that the differences in survival curves were not significant (χ=1.933, P=0.16) for the BMI groups. This was supported by the Cox proportional hazard model (P=0.36).
CONCLUSIONBMI appears to be important in predicting ADA efficacy (LOR) in CD. IFX appears to overcome this reduction of efficacy in obese patients. A prospective study evaluating the effect of weight on anti-TNF drug response and serum drug levels is warranted.</description><subject>Adalimumab</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Antibodies, Monoclonal, Humanized - administration & dosage</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Body Mass Index</subject><subject>Body Weight - physiology</subject><subject>Crohn Disease - complications</subject><subject>Crohn Disease - drug therapy</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Drug Tolerance - physiology</subject><subject>Female</subject><subject>Gastrointestinal Agents - administration & dosage</subject><subject>Gastrointestinal Agents - therapeutic use</subject><subject>Humans</subject><subject>Infliximab</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity - complications</subject><subject>Obesity - physiopathology</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><subject>Young Adult</subject><issn>0954-691X</issn><issn>1473-5687</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLFOwzAQhi0EoqXwBghlZEmx49hOJoRKKUhFLCCxRU58JS5JXGyHio3X4PV4ElwVGBiYTrr7_v_ufoSOCR4TnIuz2-lsjEtMKNAko0yRBWE7aEhSQWPGM7GLhjhnacxz8jhAB84tMSaCErGPBgmlVBCBh6i-NOCiNein2sdSLXvnQUWy8zr2fWt6G3VQWeO0ixay8sZG3oL0LXQ-NF43gCnBQbSSXodm8NK-jibW1N3n-4eLlHYgHZwfor2FbBwcfdcReria3k-u4_nd7GZyMY8ryjiLU15BIitFw7GEEckTXmaSiorxnCeEV1wlZV6GWa5oQjJFIcxolkKqcCY5HaHTre_KmpcenC9a7SpoGtmB6V1BgkrkScZYQNMtunnQWVgUK6tbad8KgotNxkXIuPibcZCdfG_oyxbUr-gn1ABkW2BtGg_WPTf9GmxRg2x8_b_3F0qKjF8</recordid><startdate>201305</startdate><enddate>201305</enddate><creator>Bhalme, Mahesh</creator><creator>Sharma, Abhishek</creator><creator>Keld, Richard</creator><creator>Willert, Robert</creator><creator>Campbell, Simon</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201305</creationdate><title>Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn’s disease?</title><author>Bhalme, Mahesh ; Sharma, Abhishek ; Keld, Richard ; Willert, Robert ; Campbell, Simon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3565-46ce2acd3001151a626b8a37c5696216c6d2b9b1159d3218d3e7c5384e4d08a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adalimumab</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Antibodies, Monoclonal, Humanized - administration & dosage</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Body Mass Index</topic><topic>Body Weight - physiology</topic><topic>Crohn Disease - complications</topic><topic>Crohn Disease - drug therapy</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Drug Tolerance - physiology</topic><topic>Female</topic><topic>Gastrointestinal Agents - administration & dosage</topic><topic>Gastrointestinal Agents - therapeutic use</topic><topic>Humans</topic><topic>Infliximab</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity - complications</topic><topic>Obesity - physiopathology</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Tumor Necrosis Factor-alpha - antagonists & inhibitors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhalme, Mahesh</creatorcontrib><creatorcontrib>Sharma, Abhishek</creatorcontrib><creatorcontrib>Keld, Richard</creatorcontrib><creatorcontrib>Willert, Robert</creatorcontrib><creatorcontrib>Campbell, Simon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of gastroenterology & hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhalme, Mahesh</au><au>Sharma, Abhishek</au><au>Keld, Richard</au><au>Willert, Robert</au><au>Campbell, Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn’s disease?</atitle><jtitle>European journal of gastroenterology & hepatology</jtitle><addtitle>Eur J Gastroenterol Hepatol</addtitle><date>2013-05</date><risdate>2013</risdate><volume>25</volume><issue>5</issue><spage>543</spage><epage>549</epage><pages>543-549</pages><issn>0954-691X</issn><eissn>1473-5687</eissn><abstract>BACKGROUNDAdalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn’s disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response.
AIMTo determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable.
MATERIALS AND METHODSA hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan–Meier (KM) survival curves and a Cox proportional hazards model.
RESULTSADA patientsOf the 54 patients (46 BMI<30 and 8 BMI≥30), KM estimation indicated a significantly shorter time to dose escalation in the BMI of at least 30 (χ=6.117, P=0.01). The Cox proportional hazards model showed that an increased hazard of LOR to ADA is related to increases in BMI (P=0.04). IFX patientsOf the 76 patients (62 BMI<30 and 14 BMI≥30), KM estimation showed that the differences in survival curves were not significant (χ=1.933, P=0.16) for the BMI groups. This was supported by the Cox proportional hazard model (P=0.36).
CONCLUSIONBMI appears to be important in predicting ADA efficacy (LOR) in CD. IFX appears to overcome this reduction of efficacy in obese patients. A prospective study evaluating the effect of weight on anti-TNF drug response and serum drug levels is warranted.</abstract><cop>England</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>23337170</pmid><doi>10.1097/MEG.0b013e32835d1f15</doi><tpages>7</tpages></addata></record> |
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| subjects | Adalimumab Adolescent Adult Aged Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - therapeutic use Antibodies, Monoclonal, Humanized - administration & dosage Antibodies, Monoclonal, Humanized - therapeutic use Body Mass Index Body Weight - physiology Crohn Disease - complications Crohn Disease - drug therapy Dose-Response Relationship, Drug Drug Administration Schedule Drug Tolerance - physiology Female Gastrointestinal Agents - administration & dosage Gastrointestinal Agents - therapeutic use Humans Infliximab Kaplan-Meier Estimate Male Middle Aged Obesity - complications Obesity - physiopathology Retrospective Studies Treatment Outcome Tumor Necrosis Factor-alpha - antagonists & inhibitors Young Adult |
| title | Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn’s disease? |
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