PATIENTS WITH INFLAMMATORY BOWEL DISEASES AND HIGHER VISCERAL ADIPOSE TISSUE BURDEN MAY BENEFIT FROM HIGHER INFLIXIMAB CONCENTRATIONS TO ACHIEVE REMISSION.

INTRODUCTIONIn patients with inflammatory bowel diseases (IBD), high visceral adipose tissue burden is associated with lower response to infliximab, potentially through alterations in volume distribution and/or clearance. Differences in visceral adipose tissue may also explain heterogenicity in target trough levels of infliximab associated with favorable outcomes. The aim of this study was to assess whether visceral adipose tissue burden may be associated with infliximab cutoffs associated with efficacy in patients with IBD.METHODSWe 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. Secondary outcome was endoscopic remission within 8 weeks of infliximab level measurement.RESULTSOverall, 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 two visceral adipose tissue % quartiles (<1.2%) while optimal infliximab level cutoffs associated with steroid free deep remission for those patients in the highest two visceral adipose tissue % quartiles was 15.3 mcg/mL (J:0.63). In a multivariable analysis, only visceral adipose tissue % and infliximab level remained independently associated with steroid free deep remission (OR per % of VAT:0.3 [95%CI: 0.17-0.64], p<0.001 and OR per μg/ml:1.11 [95%CI: 1.05-1.19], p<0.001).CONCLUSIONSThe results may suggest that patients with higher visceral adipose tissue burden may benefit of achieving higher infliximab levels to achieve remission.