High body mass index is associated with increased risk of treatment failure and surgery in biologic‐treated patients with ulcerative colitis

Kurnool, Soumya; Nguyen, Nghia; Proudfoot, James; Dulai, Parambir S.; Boland, Brigid S.; Casteele, Niels Vande; Evans, Elisabeth; Grunvald, Eduardo; Zarrinpar, Amir; Sandborn, William J.; Singh, Siddharth

doi:10.1111/apt.14665

Cited by 66 publications

(59 citation statements)

References 30 publications

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“…One randomized controlled trial showed that weight reduction in patients yielded improved Psoriasis Area and Severity Index scores . Moreover, a retrospective cohort study demonstrated that obesity was independently associated with biologic treatment failure in biologic‐treated patients with ulcerative colitis . The results of the current study, in consideration with the previous studies, underscore the importance of managing weight in patients with psoriasis to improve treatment persistence and therefore therapeutic outcome.…”

Section: Discussionsupporting

confidence: 65%

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

et al. 2019

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Summary Background Long‐term therapy for psoriasis is impaired by gradual loss of effectiveness and treatment discontinuation. Identifying factors that affect biologic drug survival may help in treatment optimization. Objectives To identify factors that predicted biologic drug persistence or discontinuation in a real‐life setting. Methods We identified studies of biologic persistence in psoriasis through a comprehensive, systematic literature search using predefined search criteria. Studies were screened by title and abstract then further by full‐text review. Hazard ratio (HR) data were extracted for all available predictive factors (HRs > 1 denoted biologic discontinuation, and HRs < 1 denoted biologic persistence). A meta‐analysis of HRs (random‐effects model) was used to assess any predictive factor included in at least two studies. Results Sixteen cohort studies were included in the review, with a total of 32 194 patients. A meta‐analysis was performed on 13 studies (n = 29 802): nine for female sex (n = 28 090), six for obesity (n = 9311) and six for psoriatic arthritis (n = 24 444). Obesity and female sex predicted treatment discontinuation, with HRs of 1.21 [95% confidence interval (CI) 1.10–1.32, I2 = 0%] and 1.22 (95% CI 1.07–1.38, I2 = 84%), respectively. Concomitant psoriatic arthritis predicted biologic persistence (HR 0.83, 95% CI 0.80–0.86, I2 = 0%). Female sex predicted biologic discontinuation due to side‐effects, with a pooled HR of 2.16 (95% CI 1.39–3.35, I2 = 67%). Other reported predictive factors (smoking, metabolic syndrome, biologic naivety, age, Dermatology Life Quality Index, dyslipidaemia, high socioeconomic status and concomitant methotrexate) were insufficiently reported for meta‐analysis. Conclusions Our meta‐analysis demonstrates that female sex and obesity predict biologic discontinuation, and concomitant psoriatic arthritis predicts biologic survival. What's already known about this topic? Ineffectiveness is the main factor that causes drug discontinuation during long‐term treatment of psoriasis. It is unclear which factors and comorbidities impact drug persistence. What does this study add? Female sex and obesity predict biologic discontinuation due to ineffectiveness and adverse events. Concomitant psoriatic arthritis is associated with improved drug persistence.

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Section: Discussionsupporting

confidence: 65%

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

et al. 2019

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“…This contrasts with recent findings showing that higher body mass index (BMI) is associated with an increased risk of treatment failure and surgery in biologic-treated patients with UC, however, this was observed mostly for patients who were overweight (BMI, !25 kg/m 2 ) or obese (BMI, !30 kg/m 2 ). 23 Unfortunately, BMI was not available as a size measure in the current data set to evaluate similar cut-off values for obesity. Variables associated with endoscopic healing at week 30 were as follows: no use of corticosteroids at baseline, female sex, and higher week 30 IFX concentration.…”

Section: Discussionmentioning

confidence: 99%

Infliximab Exposure-Response Relationship and Thresholds Associated With Endoscopic Healing in Patients With Ulcerative Colitis

Casteele

Jeyarajah

Jairath

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Therapeutic drug monitoring might be used to personalize infliximab treatment of patients with ulcerative colitis (UC), although exposure thresholds associated with endoscopic healing are uncertain. We aimed to determine infliximab concentration thresholds associated with endoscopic outcomes during induction and maintenance therapy for patients with UC. METHODS: We analyzed data from 484 patients with active UC included in 2 randomized controlled trials of infliximab vs placebo. Mayo endoscopic scores (MES) were available from weeks 0, 8, and 30. A 2-compartment population pharmacokinetic model was used to calculate infliximab clearance at baseline. We tested the linear trend between baseline infliximab clearance and MES at week 8. Receiver operating curve analysis identified infliximab clearance and concentration thresholds with a maximum Youden index corresponding to a MES of 0 or £1. RESULTS: We found a linear relationship between baseline infliximab clearance and week 8 MES (P < .001); a threshold of <0.397 L/d was associated with week 8 MES £1. Infliximab concentrations ‡18.6 mg/mL at week 2, ‡10.6 mg/mL at week 6, and ‡34.9 mg/mL at week 8 were associated with a week 8 MES of £1. Infliximab concentrations ‡5.1 mg/mL at week 14 and ‡2.3 mg/mL at week 30 were associated with a week 30 MES of £1. Infliximab concentrations ‡6.7 mg/mL at week 14 and ‡3.8 mg/mL at week 30 were associated with a week 30 MES of 0. CONCLUSIONS: Baseline clearance of infliximab and drug concentrations during induction and maintenance infliximab therapy are associated with short-and long-term endoscopic healing. Interventional studies that incorporate individualized dosing based on these parameters are required to show improved patient outcomes.

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“… 17 , 25 , 26 Obesity is associated with persistent disease activity, has been shown to negatively impact biologic therapy and surgical outcomes, and is associated with poorer mental health (anxiety and depression). 27 , 28 Routine nutrition screening will also assist in early identification of unhealthy weight gain and patients requiring individualized counseling to prevent unwanted weight increases ( Figure 1 ). 10 …”

Section: Ibd Dietary Recommendations During Sars-cov2 Pandemic: Optimmentioning

confidence: 99%

Practical Guidance for Dietary Management of Patients With Inflammatory Bowel Disease During the SARS-CoV2 Pandemic

Day

Wood

Halmos

et al. 2021

Journal of the Academy of Nutrition and Dietetics

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High body mass index is associated with increased risk of treatment failure and surgery in biologic‐treated patients with ulcerative colitis

Abstract: BMI is independently associated with increased risk of treatment failure in biologic-treated patients with UC, independent of dosing regimen.

Cited by 66 publications

References 30 publications

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

Infliximab Exposure-Response Relationship and Thresholds Associated With Endoscopic Healing in Patients With Ulcerative Colitis

Practical Guidance for Dietary Management of Patients With Inflammatory Bowel Disease During the SARS-CoV2 Pandemic

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