Obesity Is Not Associated With an Increased Risk of Serious Infections in Biologic-Treated Patients With Inflammatory Bowel Diseases

Abstract

INTRODUCTION: Obesity has been associated with adverse disease-related outcomes and inferior treatment response to biologic agents in patients with inflammatory bowel diseases (IBDs), but its impact on the risk of treatment-related complications is unknown. We performed a cohort study examining the association between obesity and risk of serious infections in biologic-treated patients with IBD. METHODS: Using an administrative claims database, in a cohort of biologic-treated patients with IBD between 2014 and 2018 with follow-up 1 year before and after treatment initiation, we compared the risk of serious infections (infections requiring hospitalization) between obese vs nonobese patients (based on validated administrative claims) using Cox proportional hazard analysis. RESULTS: We included 5,987 biologic-treated patients with IBD (4,881 on tumor necrosis factor-α antagonists and 1,106 on vedolizumab), of whom 524 (8.8%) were classified as obese. Of the 7,115 person-year follow-up, 520 patients developed serious infection. Risk of serious infection was comparable in obese vs nonobese patients (8.8% vs 8.5%; unadjusted hazard ratio, 1.15; 95% confidence interval, 0.86–1.54). After adjusting for age, comorbidities, disease characteristics, health care utilization, use of corticosteroids, immunomodulators, and opiates, obesity was not associated with an increased risk of serious infection (adjusted hazard ratio, 0.74 [95% confidence interval, 0.55–1.01]). Similar results were seen on stratified analysis by disease phenotype (Crohn's disease and ulcerative colitis) and index biologic therapy (tumor necrosis factor-α antagonists and vedolizumab). DISCUSSION: After adjusting for comorbid conditions and disease characteristics, obesity is not independently associated with an increased risk of serious infections in biologic-treated patients with IBD.

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

“…In this large, multicenter, EHR-based cohort study of more than 3,000 patients with IBD starting new biologic therapy, of whom 14% were obese, we found obesity was not associated with risk of hospitalization, IBD-related surgery, or serious infections after adjusting for confounding factors within 1 year of initiating biologic therapy. We also confirmed previously observed risk factors independent from obesity for adverse treatment outcomes and serious infections with biologic therapy, including high burden of comorbidities, concomitant corticosteroid and opiate use, elevated CRP at baseline, and previous hospitalization (17,27). Our findings suggest obesity does not significantly affect unplanned healthcare utilization and treatment-related complications in patients with IBD starting new biologic therapy.…”

“…Recent large database studies use administrative claims that rely on diagnostic codes for the diagnosis of obesity, resulting in misclassification. In addition, there is limited data defining the effect of obesity on treatment-related complications, particularly risk of serious infections (17). Thus, clarifying the effect of obesity on treatment outcomes and risk of complications is critical for improving IBD management.…”

Tofacitinib for the Treatment of Ulcerative Colitis: An Integrated Summary of up to 7.8 Years of Safety Data from the Global Clinical Programme

“… 16 However, a previous analysis of patients with IBD receiving biological therapy reported that obesity was not associated with an increased risk of serious infections. 17 …”

Network pharmacology for systematic understanding of Schisandrin B reduces the epithelial cells injury of colitis through regulating pyroptosis by AMPK/Nrf2/NLRP3 inflammasome

“…The disorder of the intestinal epithelial barrier plays an important role in the inflammatory process [ 40 ]. Therefore, it is necessary to clarify the potential mechanism of intestinal epithelial barrier damage induced by UC inflammation to identity novel therapeutic approaches [ 41 ]. In this study, we found that Schisandrin B presented colitis and reduced inflammation in vivo and vitro model of colitis.…”