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European Journal of Clinical Nutrition (2017) 71, 773777 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0954-3007/17
http://www.nature.com/ejcn
Web End =www.nature.com/ejcn
ORIGINAL ARTICLE
Low muscle mass at initiation of anti-TNF therapy for inammatory bowel disease is associated with early treatment failure: a retrospective analysis
DQ Holt1,2, P Varma1, BJG Strauss2, AS Rajadurai2 and GT Moore1,2
BACKGROUND/OBJECTIVES: Delayed treatment failure occurs in a signicant proportion of inammatory bowel disease (IBD) patients treated with tumor necrosis factor-alpha (TNF) antagonists. Identication of predictors of loss of response (LOR) may help to optimize therapy. We sought to determine whether body composition parameters at the commencement of anti-TNF therapy were associated with earlier treatment failure.
SUBJECTS/METHODS: A retrospective cohort study was performed on 68 patients who had undergone cross-sectional abdominal imaging coincident with the commencement of anti-TNF drugs. Analysis of the images at the third lumbar vertebra was performed using standard techniques to determine cross-sectional areas of skeletal muscle (SM), visceral adipose tissue, subcutaneous adipose tissue and intermuscular adipose tissue. Treatment failure was dened as: post-induction hospital admission or surgery for IBD, escalation of TNF dose or immunosuppressants for clinical LOR, emergence of a new stula or Crohns Disease Activity Index (CDAI) 4150.
RESULTS: Two-thirds of patients had myopenia. Patients with less than gender-specic median SM area had a median time to failure of 520 (s.d. 135) days compared to 1100 (s.d. 151) days for those with more than median SM area (P = 0.036). No difference was found in disease duration, inammatory markers or CDAI between quartiles of SM area. No relation between outcomes and measures of adipose tissue, weight or body mass index was observed.
CONCLUSIONS: Identifying low muscle mass at anti-TNF induction as a risk factor for treatment failure may contribute to a more
tailored approach to IBD therapy.
European Journal of Clinical Nutrition (2017) 71, 773777; doi:http://dx.doi.org/10.1038/ejcn.2017.10
Web End =10.1038/ejcn.2017.10 ; published online 22 February 2017
INTRODUCTIONMonoclonal antibodies to tumor necrosis factor-alpha (anti-TNF drugs) have an established role in the treatment of inammatory bowel disease (IBD),1,2 with initial response rates of ~ 80% in induction and early maintenance studies.3,4 However, primary non-response to anti-TNF drugs occurs in 1340% of patients, with ~ 13% of patients experiencing secondary loss of response (LOR) each year.5...