Rapid weight gain in infliximab treated Crohn’s disease patients is sustained over time: real-life data over 12 months

Figures & data

Table 1. Baseline characteristics of 110 Crohn’s disease patients starting infliximab treatment.

	Total n = 110	Men n = 77 (70%)	Women n = 33 (30%)	p-value
Age: year (Mean (range)) (SD)	34 years (range 14–73) (13.3)	33 (range 14–73) (13.3)	36 (range 15–66) (13.3)	p = .24
Weight (mean (SD))	69.8 kg (14.8)	72.3 kg (14.5)	63.8 (14.0)	p = .005
(median (IQR))	68.0 (17.0)	70.0 (12.0)	60.0 (12.3)
BMI (mean (SD))	22.9 (4.6)	22.7 (4.0)	23.3 (5.7)	p = .51
(median (IQR))	22.2 (4.8)	22.3 (4.6)	21.7 (5.3)
Disease activity (PGA)^a	2.0 (0.8)^a	1.9 (0.8)^a	2.1 (0.8)^a	p = .15
Endoscopic inflammation (SES-CD)^b	11.5 (7.0)^b	11.0 (6.7)^b	11.8 (7.9)^b	p = .85
Inflammatory markers
Hb (mean (SD))	128.7 g/L (15.4)	131.5 (15.0)	121.7 (14.3)	p = .003
Alb (mean (SD))	35.1 g/L (5.0)	35.3 (4.8)	34.6 (5.6)	p = .49
CRP (mean (SD))	19.6 mg/L (24.7)	21.9 (26.8)	14.5 (18.4)	p = .16
Disease behaviour
Fistulising	56 (51)	38 (49%)	18 (55%)
Luminal	54 (49)	39 (51%)	15 (45%)
Previous surgery	27 (25)	16 (21%)	11 (33%)
Montreal classification (n = 107)^c
Ileal, L1	18	14	4
Colonic, L2	47	29	18
Ileocolonic, L3	42	32	10
Co-medication
Azathioprine	42 (38%)	29 (26%)	13 (12%)
Glucocorticosteroids	17 (15%)	12 (11%)	5 (5%)
Azathioprine plus Glucocorticosteroids	25 (23%)	19 (17%)	6 (5%)

BMI: Body mass index (= weight (kg)/height (m) × height (m)); Hb: Haemoglobin; Alb: Albumin; CRP: C-reactive protein; SD: standard deviation; IQR: interquartile range; kg: kilogram; g/L: gram per liter; mg/L: milligram per liter.

^aDisease activity in the form of PGA (physician global assessment); n = 106 patients.

^bEndoscopic grading in the form of SES-CD; n = 34 patients.

^cDisease location according to the Montreal classification.

Figure 1. (A) Weight increment in Crohn’s disease patients during induction and maintenance treatment with infliximab. There was a significant increase in weight at all time points compared to baseline (p < .001). The median increase in weight was 1.7 kg (IQR = 3.1 kg) at 6 weeks of treatment, which persisted at 3 and 12 months, 2.4 kg (IQR = 4.7 kg) and 3.0 kg (IQR = 6.4 kg), respectively. (B) BMI increment in Crohn’s disease patients during induction and maintenance treatment with infliximab. There was a significant increase in BMI at all time points (p < .001). The median increase in BMI was 0.5 kg/m² (IQR = 1.2 kg/m²) at 6 weeks of treatment, which persisted at 3 and 12 months, BMI; 0.7 kg/m² (IQR = 1.5 kg/m²) and 1.0 kg/m², (IQR = 2.2 kg/m²), respectively.

Figure 2. Underweight Crohn’s disease patients at baseline increased more in weight than normal, overweight and obese patients at 6 weeks of treatment (p < .05). Patients with a normal BMI at baseline increased more in weight at 12 months compared to overweight patients (p < .01).

Table 2. Weight and BMI increases during infliximab-treatment stratified for disease type in 110 Crohn’s disease patients.

	6 weeks	95% CI	p-value	3 months	95% CI	p-value	12 months	95% CI	p-value
Weight
Fistulising disease;	2.1 kg	–0.6 to 1.5	p = .4	3.1	–0.9 to 1.9	p = .5	5.2 kg	0.4–5.0	p < .05
Luminal disease;	1.6 kg			2.5			2.5 kg
BMI
Fistulising disease;	0.7 kg/m^2	–0.1 to 0.6	p = .2	1.1 kg/m^2	–0.2 to 0.7	p = .3	1.7 kg/m^2	0.1–1.6	p < .05
Luminal disease;	0.5 kg/m^2			0.8 kg/m^2			0.8 kg/m^2

Patients with fistulising disease (n = 56) increased significantly more in weight and BMI at 12 months of infliximab treatment compared with patients with luminal disease (n = 54). Mean values and 95% confidence intervals.

Table 3 Changes in inflammatory markers in 110 Crohn’s disease patients under infliximab treatment (77 men, 33 women).

(A) Inflammatory markers improved as early as 6 weeks of treatment. P-values denote changes compared to baseline values. Mean values with 95% confidence intervals.
Inflammatory markers	6 weeks	95% CI	p-value	3 months	95% CI	p-value	12 months	95% CI	p-value
CRP (mg/L)	−12.4	−17 to (–6.9)	p < .001	−14.0	−19.2 to (–8.7)	p < .001	−13.1	−19.3 to (6.9)	p < .001
Haemoglobin (g/L)	2.0	−0.4 to 4.5	p = .1	5.5	2.9–8.1	p < .001	9.8	6.3–13.2	p < .001
Albumin (g/L)	3.2	2.2–4.1	p < .001	3.9	3.0–4.9	p < .001	3.9	2.7–5.2	p < .001
(B) Serum albumin significantly increased and CRP decreased at all time points during treatment in men. An increase in albumin was only significant in women at 3 and 12 months. There was an increase in haemoglobin at 12 months of treatment both in men and women. Mean values with 95% confidence intervals.
	6 weeks		3 months		12 months
Inflammatory markers	Men	Women	Men	Women	Men	Women
CRP; (mg/L) (95%CI)	−14.3^c (–21.7 to (–6.9))	8.0^a (–14.6 to 1.3)	−15.8^c (–22.5 to (–9.0)	−9.6^a (–17.7 to (–1.5)	−15.1^c (–23.4 to (–6.9)	8.9^a (17.6 to (–0.2)
Haemoglobin; (g/L) (95%CI)	2.5 (–0.5 to 5.5) p = 0.1	0.9 (–3.3 to 5.1) (p = 0.7)	5.4^b (1.9–8.9)	5.5^b (2.3–8.8)	11.4^c (6.9–16.0)	6.1^a (1.4–10.8)
Albumin; (g/L) (95%CI)	3.7^c (2.5–4.8)	−1.9^a (0.2–3.6)	4.0^c (2.9–5.1)	3.8^c (2.0–5.6)	4.0^c (2.6–5.3)	3.8^a (0.8–6.8)

^ap < .05, ^bp < .01, ^cp < .001 compared to baseline values.