Visceral Adipose Tissue Volumetrics Inform Odds of Treatment Response and Risk of Subsequent Surgery in IBD Patients Starting Antitumor Necrosis Factor Therapy

Phillip Gu; Avneesh Chhabra; Punya Chittajallu; Christopher Chang; Denisse Mendez; Andrew Gilman; David I Fudman; Yin Xi; Linda A Feagins

doi:10.1093/ibd/izab167

Visceral Adipose Tissue Volumetrics Inform Odds of Treatment Response and Risk of Subsequent Surgery in IBD Patients Starting Antitumor Necrosis Factor Therapy

Inflamm Bowel Dis. 2022 May 4;28(5):657-666. doi: 10.1093/ibd/izab167.

Authors

Phillip Gu^{1

2}, Avneesh Chhabra³, Punya Chittajallu⁴, Christopher Chang², Denisse Mendez², Andrew Gilman^{1

2}, David I Fudman^{1

2}, Yin Xi^{3

5}, Linda A Feagins⁶

Affiliations

¹ Division of Digestive and Liver Diseases, UT Southwestern, Dallas,TX, USA.
² Department of Internal Medicine, UT Southwestern, Dallas,TX, USA.
³ Division of Musculoskeletal Radiology, Department of Radiology, UT Southwestern, Dallas,TX, USA.
⁴ Department of Internal Medicine, UCLA, Los Angeles,CA, USA.
⁵ Department of Population and Data Sciences, UT Southwestern, Dallas,TX, USA.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin,TX, USA.

PMID: 34291800
DOI: 10.1093/ibd/izab167

Abstract

Background: Data describing the effect of obesity on antitumor necrosis factor (anti-TNF) treatment response are inconsistent. Visceral adipose tissue (VAT) is a superior marker of adiposity to body mass index. However, its effect on treatment response is unclear. We aimed to evaluate the effect of VAT on anti-TNF treatment response.

Methods: Inflammatory bowel disease (IBD) patients starting anti-TNF agents between January 1, 2009, and July 31, 2019, were included. 3-dimensional measurements of VAT volume and visceral fat index (visceral:subcutaneous adipose tissue ratio; VFI) were obtained from computed tomography (CT) scans. Subjects were categorized by predefined volume cutoffs (<1500cm3, 1500-2999cm3, ≥3000cm3) and VFI (<0.33, 0.33-0.66, ≥0.67). Primary outcomes included a composite treatment response end point at 6 and 12 months. Secondary outcomes were surgery at 6 and 12 months. Multivariable logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: The final cohort included 176 patients. No significant differences in treatment response at 6 months was observed. At 12 months, compared with volume <1500cm3, patients with volume 1500-2999cm3 had higher odds of response (aOR, 3.52; 95% CI, 1.16-10.71; P = .023), whereas volume ≥3000cm3 did not. Compared with VFI<0.33, VFI ≥0.67 had higher odds of surgery at 6 (aOR, 48.22; 95% CI, 4.73-491.57; P = .023) and 12 months (aOR, 20.94; 95% CI, 3.14-139.67; P = .004). Post hoc analysis suggested VAT may affect drug pharmacokinetics.

Conclusions: We found VAT volume is associated with anti-TNF treatment response in a nondose dependent manner, and VFI may inform risk of surgery after anti-TNF initiation. If confirmed by prospective studies, VAT volumetrics are potentially useful biomarkers to inform IBD treatment decisions.

Keywords: Crohn’s disease; anti-tumor necrosis factor; inflammatory bowel disease; ulcerative colitis; visceral adipose tissue.

Plain language summary

Visceral adipose tissue volume is associated with anti-TNF treatment response in a nondose response manner. Additionally, high visceral fat index is associated with significantly increased risk of early surgery after anti-TNF initiation.

MeSH terms

Body Mass Index
Humans
Inflammatory Bowel Diseases* / drug therapy
Inflammatory Bowel Diseases* / surgery
Intra-Abdominal Fat* / diagnostic imaging
Necrosis
Prospective Studies
Risk Factors
Tumor Necrosis Factor Inhibitors / therapeutic use

Substances

Tumor Necrosis Factor Inhibitors