Obesity is common among patients with pediatric Crohn's disease (PCD). Some adult studies suggest obese patients respond less well to anti-tumor necrosis factor (TNF) treatment. This study compares anti-TNF response and anti-TNF levels between pediatric patients with normal and high body mass index (BMI).

Why was this study done?

Several studies have shown that adults with IBD who are overweight or obese have worse outcomes and that being overweight or obese was associated with higher rates of increased medication dosing. This is an important observation as there have been an increased number of pediatric IBD patients who are overweight or obese. This study used data from the COMBINE trial, which was completed within the ICN network.

Study overview

The purpose of this sub-study was to evaluate the outcomes of pediatric patients with normal BMI (measure of body weight for height) compared to those with higher BMI. BMI did not make a difference in patients treated with infliximab, however, patients with higher BMIs treated with adalimumab were more likely to meet the study outcome of treatment failure (they had a flare or did not reach remission). They were also found to have lower adalimumab levels in their blood than normal weight participants.

Study limitations

A limitation to this study was that it did not include patients whose BMI was higher than the 98th percentile as those with higher BMIs had increased risk of having abnormal liver labs. Because of this it limited the number of patients with higher BMIs and may have affected the results of this study. Another limitation was that only a small number of patients with high BMI were treated with adalimumab (12 out of 52 normal BMI patients whereas 7 out of 10 with high BMI had treatment failure) so these differences may not be seen in a study with a larger number of patients.

What does this mean for patients, families and clinicians?

Because dosing of adalimumab (only available in 20, 40, and 80 mg) cannot be adjusted as easily for weight as dosing of infliximab, more frequent drug level monitoring should be considered and doses adjusted accordingly, for pediatric patients with IBD who are overweight or obese.

Study authors

Ebach DR, Jester TW, Galanko JA, Firestine AM, Ammoury R, Cabrera J, Bass J, Minar P, Olano K, Margolis P, Sandberg K, Linnville TM, Kaplan J, Pitch L, Steiner SJ, Bass D, Moses J, Adler J, Gulati AS, Wali P, Pashankar D, Ivanova A, Herfarth H, Wohl DA, Benkov KJ, Strople J, Sullivan J, Tung J, Molle-Rios Z, Saeed SA, Bousvaros A, Kappelman MD.

Study stats

This study was published in March 2024. You can locate it on our website and online in The American Journal of Gastroenterology

  • Study citation: Ebach DR, Jester TW, Galanko JA, Firestine AM, Ammoury R, Cabrera J, Bass J, Minar P, Olano K, Margolis P, Sandberg K, Linnville TM, Kaplan J, Pitch L, Steiner SJ, Bass D, Moses J, Adler J, Gulati AS, Wali P, Pashankar D, Ivanova A, Herfarth H, Wohl DA, Benkov KJ, Strople J, Sullivan J, Tung J, Molle-Rios Z, Saeed SA, Bousvaros A, Kappelman MD. High Body Mass Index and Response to Anti-Tumor Necrosis Factor Therapy in Pediatric Crohn's Disease. Am J Gastroenterol. 2024 Jun 1;119(6):1110-1116. doi: 10.14309/ajg.0000000000002741. Epub 2024 Mar 6. PMID: 38445644; PMCID: PMC11150092.
  • Study sharing: This article is copyrighted by The American College of Gastroenterology. Interested parties can request permission for reusing this content via the original article.

🔎 This ICN Research Explained was prepared by: Dawn Ebach, MD, Medical Director, Pediatric Procedure Unit, University of Iowa Stead Family Children's Hospital and David Wohl, Parent, ICN Research Committee
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