Effect of Obesity on Risk of Hospitalization, Surgery, and Serious Infection in Biologic-Treated Patients With Inflammatory Bowel Diseases: A CA-IBD Cohort Study

Abstract

INTRODUCTION: Obesity is variably associated with treatment response in biologic-treated patients with inflammatory bowel diseases (IBD). We evaluated the association between obesity and risk of hospitalization, surgery, or serious infections in patients with IBD in new users of biologic agents in a large, multicenter, electronic health record (EHR)-based cohort (CA-IBD). METHODS:We created an EHR-based cohort of adult patients with IBD who were new users of biologic agents (tumor necrosis factor [TNF-a] antagonists, ustekinumab, and vedolizumab) between January 1, 2010, and June 30, 2017, from 5 health systems in California. Patients were classified as those with normal body mass index (BMI), overweight, or obese based on the World Health Organization classification. We compared the risk of all-cause hospitalization, IBD-related surgery, or serious infections among patients with obesity vs those overweight vs those with normal BMI, using Cox proportional hazard analyses, adjusting for baseline demographic, disease, and treatment characteristics. RESULTS:Of 3,038 biologic-treated patients with IBD (69% with Crohn's disease and 76% on TNF-a antagonists), 28.2% (n 5 858) were overweight, and 13.7% (n 5 416) were obese. On a follow-up after biologic initiation, obesity was not associated with an increased risk of hospitalization (adjusted hazard ratio [aHR] vs normal BMI, 0.90; [95% confidence interval, 0.72-1.13]); IBD-related surgery (aHR, 0.62 [0.31-1.22]); or serious infection (aHR,). Similar results were observed on stratified analysis by disease phenotype (Crohn's disease vs ulcerative colitis) and index biologic therapy (TNF-a antagonists vs non-TNF-a antagonists).

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“…Since NAFLD is strongly associated with obesity, it is difficult to separate its impact from that of obesity in general on IBD outcomes. As there exists a significant body of literature on the latter association [41][42][43][44][45][46], careful assessment of any supplementary negative impact attributable to NAFLD is required. In our review, only three studies controlled for obesity in their multivariate regression model [18].…”

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“…Third, obesity was not a significant risk factor for additional risks related to IBD, specifically, the risk of hospitalisation, surgery and serious infections,38 even when stratified by disease phenotype or TNFα inhibitor vs non-TNFα biological therapy.…”

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“…An interesting study investigated the disease course of 3038 biologic‐treated IBD patients with IBD, of whom 28.2% were overweight ( n = 858) and 13.7% ( n = 416) were obese. In this report, obesity was not associated with more biologic therapy‐related infections or a higher risk of hospitalization or IBD‐related surgery [19].…”