Effects of visceral adipose tissue on anti-tumour necrosis factor-α in Crohn’s disease

BACKGROUND: It remains unclear whether visceral adipose tissue (VAT) can predict the response of patients with Crohn’s disease (CD) to anti-tumour necrosis factor-α (anti-TNF-α) therapy. OBJECTIVES: This study aimed to investigate whether VAT predicts the efficacy of infliximab (IFX) for different sites of CD and its relationship with serum TNF-α levels and IFX serum trough concentration. DESIGN: This is a multicentre retrospective study. METHODS: Patients with CD treated with IFX from January 2014 to January 2021 were included. The perimeter of the visceral adipose area was obtained by a Computed Tomography (CT) scan. Participants were classified according to the lesion site (L(1), L(2), and L(3)) and visceral fat area. The participants were divided into colon-uninvolved non-visceral obesity (L(1)-VAT(L)), colon-uninvolved visceral obesity (L(1)-VAT(H)), colon-involved non-visceral obesity (L(2) + L(3)-VAT(L)), and colon involved visceral obesity (L(2) + L(3)-VAT(H)) groups. The end points of this study were set as disease remission status at 6 and 12 months. RESULTS: The final cohort included 140 patients. Regarding efficacy at 6 and 12 months, there was a significant difference between L(1)-VAT(L) (73.8% versus 36.8%, p = 0.006) and L(1)-VAT(H) (81.0% versus 47.4%, p = 0.008) groups. In the analysis of serum TNF-α levels and IFX serum trough concentrations, there was a significant difference between L(1)-VAT(L) and L(1)-VAT(H) (59.5 pg/mL versus 236.0 pg/mL, p(TNF-α) = 0.006), (10.0 μg/mL versus 0.4 μg/mL, p(IFX) = 0.000), and L(1)-VAT(H) and L(2) + L(3)-VAT(H) (78.7 pg/mL versus 118.6 pg/mL, p(TNF-α) = 0.031), (0.4 μg/mL versus 6.40 μg/mL, p(IFX) = 0.017). CONCLUSION: In L(1) patients, the VAT level predicted the efficacy of IFX, with high VAT values indicating poor efficacy. The VAT level may be a useful radiological marker to predict the efficacy of IFX in patients with various types of CD.