692 Impact of Body Mass Index on Efficacy of Infliximab in Children With Inflammatory Bowel Disease

Grossi, Victoria; Lerer, Trudy; Markowitz, James; Griffiths, Anne M.; Evans, Jonathan P; Bousvaros, Athos; Mack, David R.; Otley, Anthony; Pfefferkorn, Marian D.; Rosh, Joel R.; Oliva‐Hemker, Maria; Saeed, Shehzad Ahmed; Deslandres, Colette; Carvalho, Ryan; Grossman, Andrew B.; Keljo, David J.; Kappelman, Michael D.; Hitch, Meredith C.; Sudel, Boris; Rick, James; Cabrera, José; Faubion, William A.; Leleiko, Neal S.; Hyams, Jeffrey S.

doi:10.1016/s0016-5085(13)60459-x

Cited by 1 publication

(2 citation statements)

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“…In contrast to the inverse association of BMI with infliximab dose escalation, we observed a trend toward higher BMI z score predicting infliximab failure. This finding is similar to that reported in an abstract of high BMI associated with decreased likelihood of 6-month remission in children with UC, but not CD (19). We can speculate that extremely low BMI may represent severe malnutrition-associated worse disease severity, higher TNF and/or inflammatory burden, and increased gut protein loss, which may lead to a higher infliximab requirement; however, long-term, among more normal-weight and overweight individuals, high BMI may adversely affect infliximab response, perhaps because of the additional TNF burden of excess adipose tissue (20,21) Infliximab is cleared through the reticuloendothelial system, which is activated in the presence of high systemic inflammation (14).…”

Section: Discussionsupporting

confidence: 90%

“…This finding is similar to that reported in an abstract of high BMI associated with decreased likelihood of 6-month remission in children with UC, but not CD. 19 We can speculate that very low BMI may represent severe malnutrition associated worse disease severity, higher TNF and/or inflammatory burden, and increased gut protein loss, which may lead to a higher infliximab requirement. However, long-term, amongst more normally weighted and overweight individuals, high BMI may adversely effects infliximab response, perhaps due to the additional TNF burden of excess adipose tissue 20, 21 …”

Section: Discussionmentioning

confidence: 99%

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Outcomes Following Infliximab Therapy for Pediatric Patients Hospitalized With Refractory Colitis–Predominant IBD

Falaiye¹,

Mitchell²,

Lu³

et al. 2014

J. pediatr. gastroenterol. nutr.

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Objectives While randomized trials demonstrated efficacy of infliximab for both pediatric Crohn’s disease (CD) and ulcerative colitis (UC), few patients in these studies exhibited colitis requiring hospitalization. The aims of this study were to determine the rate of subsequent infliximab failure and dose escalation in pediatric patients started on infliximab during hospitalization for colitis-predominant IBD, and to identify potential predictors of these endpoints. Methods Single center retrospective cohort study of patients admitted from 2005 to 2010 with Crohn’s colitis, UC, or IBD-unspecified (IBD-U) and initiated on infliximab. Results We identified 29 patients (12 Crohn’s colitis, 15 UC, and 2 IBD-U; median age 14 years) with a median follow-up of 923 days. 18 patients (62%) required infliximab dose escalation (increased dose or decreased infusion interval). Infliximab failure occurred in 18 patients (62%), due to ineffectiveness in 12 (67%) and adverse reactions in 6 (33%). 12 patients (41%) underwent colectomy. Subsequent need for infliximab dose escalation was associated with lower body mass index (BMI) z-score (P=0.01), lower serum albumin (P=0.03), and higher ESR (P=0.002) at baseline. ESR predicted subsequent infliximab dose escalation with an area under the curve of 0.89 (95% CI 0.72–1.00) and a sensitivity and specificity at a cutoff of 38 mm/hr of 0.79 (95% CI 0.49–0.95) and 0.88 (95% CI 0.47–0.99), respectively. Conclusions Most hospitalized pediatric patients with colitis treated with infliximab require early dose escalation and fail the drug long term. Low BMI and albumin, and high ESR may identify patients who would benefit from a higher infliximab starting dose.

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