Obesity increases the risk of immunogenicity to adalimumab in IBD

Obese patients with inflammatory bowel disease (IBD) who are treated with TNF inhibitor adalimumab demonstrated increased immunogenicity and lower trough levels compared with non-obese patients who were treated with this drug. Obesity was not associated with immunogenicity in patients treated with another TNF inhibitor, infliximab. These results indicate that obese IBD patients treated with adalimumab could benefit from proactive drug monitoring.

A multicentre, retrospective cohort study investigated the association between obesity and treatment response to adalimumab and infliximab in IBD patients (n=728) [1]. Treatment failure, anti-drug antibodies, and trough levels were the assessed outcome measures. Mixed-effects Cox regression analysis was used to examine the data.

In patients treated with adalimumab, obesity was significantly associated with an increased risk of developing immunogenicity (aHR 2.07; 95% CI 1.09-3.91). In addition, trough levels in obese patients on adalimumab were on average 0.20 mg/L lower than the trough levels of non-obese patients. After adjusting for confounding factors, obesity was not significantly associated with treatment failure in patients receiving adalimumab (aHR 1.40; 95% CI 0.93-2.11). However, the results trended towards an increased risk of treatment failure in these patients. Obesity was not associated with treatment failure, immunogenicity, or trough levels in patients using infliximab.

1. Mahmoud R, et al. Obesity is associated with a higher risk of immunogenicity to adalimumab, but not infliximab, in patients with IBD. P414, ECCO 2021 Virtual Congress, 2-3 & 8-10 July.

 

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Posted on 2 July 20218 April 2024