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Yarur AJ, Abreu MT, Deepak P, Beniwal-Patel P, Papamichael K, Vaughn B, Bruss A, Sekhri S, Moosreiner A, Gu P, Kennedy W, Dubinsky M, Cheifetz A, Melmed GY. Patients With Inflammatory Bowel Diseases and Higher Visceral Adipose Tissue Burden May Benefit From Higher Infliximab Concentrations to Achieve Remission. Am J Gastroenterol 2023; 118:2005-2013. [PMID: 37207314 PMCID: PMC10720850 DOI: 10.14309/ajg.0000000000002330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION In patients with inflammatory bowel diseases (IBDs), high visceral adipose tissue (VAT) burden is associated with a lower response to infliximab, potentially through alterations in volume distribution and/or clearance. Differences in VAT may also explain the heterogeneity in target trough levels of infliximab associated with favorable outcomes. The aim of this study was to assess whether VAT burden may be associated with infliximab cutoffs associated with efficacy in patients with IBD. METHODS We conducted a prospective cross-sectional study of patients with IBD receiving maintenance infliximab therapy. We measured baseline body composition parameters (Lunar iDXA), disease activity, trough levels of infliximab, and biomarkers. The primary outcome was steroid-free deep remission. The secondary outcome was endoscopic remission within 8 weeks of infliximab level measurement. RESULTS Overall, 142 patients were enrolled. The optimal trough levels of infliximab cutoffs associated with steroid-free deep remission and endoscopic remission were 3.9 mcg/mL (Youden Index [J]: 0.52) for patients in the lowest 2 VAT % quartiles (<1.2%) while optimal infliximab level cutoffs associated with steroid-free deep remission for those patients in the highest 2 VAT % quartiles was 15.3 mcg/mL (J: 0.63). In a multivariable analysis, only VAT % and infliximab level remained independently associated with steroid-free deep remission (odds ratio per % of VAT: 0.3 [95% confidence interval: 0.17-0.64], P < 0.001 and odds ratio per μg/mL: 1.11 [95% confidence interval: 1.05-1.19], P < 0.001). DISCUSSION The results may suggest that patients with higher visceral adipose tissue burden may benefit from achieving higher infliximab levels to achieve remission.
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Affiliation(s)
- Andres J. Yarur
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maria T. Abreu
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology and Hepatology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Parakkal Deepak
- Division of Gastroenterology and Hepatology, Washington University, St Louis, Missouri, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-IsraelDeaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Byron Vaughn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alexandra Bruss
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shaina Sekhri
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrea Moosreiner
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Phillip Gu
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - William Kennedy
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine Mount Sinai, New York, USA.
| | - Adam Cheifetz
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-IsraelDeaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gil Y. Melmed
- Division of Gastroenterology and Hepatology, Center for Inflammatory Bowel Diseases, Cedars Sinai Medical Center, Los Angeles, California, USA
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Sekhri S, Rao B, Mohananey A, Beniwal-Patel P, Bruss A, Stein DJ, Yarur AJ. Serum trough levels of infliximab are not associated with peripheral arthralgia activity in patients with inflammatory bowel disease. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000788. [PMID: 34764142 PMCID: PMC8587383 DOI: 10.1136/bmjgast-2021-000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Infliximab is an efficacious therapy for inflammatory bowel disease and may play a role in management of some extraintestinal manifestations. While higher trough levels of infliximab are associated with higher rates of disease remission, the association between trough levels of infliximab and arthralgia activity characterised as an extraintestinal manifestation has yet to be defined. OBJECTIVE We aimed to assess the association between serum trough levels of infliximab and peripheral arthralgia activity in patients with inflammatory bowel disease. DESIGN In this cross-sectional study, we identified patients with inflammatory bowel disease on infliximab therapy with known history of arthralgias attributed to an extraintestinal manifestation. Collected variables included disease phenotype, medications (such as thiopurines or methotrexate), Harvey Bradshaw Index, partial Mayo score, C reactive protein, trough levels of infliximab and anti-infliximab antibodies. The primary outcome was active patient-reported arthralgia. RESULTS Out of 267 patients included, 65 (24.4%) had active arthralgias at the time the trough level of infliximab was measured. No significant differences in trough levels were seen between those patients with and without arthralgias. Patients on combination therapy with methotrexate or thiopurines or those with detectable anti-infliximab antibodies were not more likely to have inactive arthralgias (OR 0.99, 95% CI 0.57 to 1.74, p=0.99 and OR 1.94, 95% CI 0.9 to 4.1, p=0.09, respectively). CONCLUSIONS This study suggests that although therapeutic drug monitoring of infliximab can have a role in the management of Crohn's disease and ulcerative colitis, it does not seem to be useful in managing arthralgias associated with inflammatory bowel disease.
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Affiliation(s)
- Shaina Sekhri
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bharat Rao
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Akanksha Mohananey
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexandra Bruss
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel J Stein
- Gastroenterology & Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andres J Yarur
- Gastroenterology & Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Sekhri S, Iyengar R, Mossner J, Mullard AJ, Krapohl GL, Campbell DA, Englesbe MJ. A New Composite Measure for Assessing Surgical Performance. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cottrell HR, Sekhri S, Arora S, Baerg T, Duncan A, Hu HM, Englesbee M, Brummett C, Waljee JF. Variation in Probability of Postoperative Opioid Prescription Refilling in the United States. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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