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Multicenter Study
. 2025 May 12;31(5):1263-1271.
doi: 10.1093/ibd/izae165.

Effect of Overweight and Obesity on the Response to Anti-TNF Therapy and Disease Course in Children With IBD

Sara Sila  1 , Marina Aloi  2 , Ugo Cucinotta  3 , Laura Gianolio  4 , Maya Granot  5 , Ondrej Hradsky  6 , Séamus Hussey  7 , Ben Kang  8 , Anna Karoliny  9 , Kaija-Leena Kolho  10 , Jan de Laffolie  11 , Sara Lega  12 , Manar Matar  13 , Lorenzo Norsa  14   15 , Sharon Omiwole  7 , Esther Orlanski-Meyer  16 , Laura Palomino  17 , Pejman Rohani  18 , Luca Scarallo  19 , Margaret Sladek  20 , Mohammad Hassan Sohouli  18 , Darja Urlep  21 , Anat Yerushalmy-Feler  22 , Eyal Zifman  23 , Iva Hojsak  1
Affiliations
Multicenter Study

Effect of Overweight and Obesity on the Response to Anti-TNF Therapy and Disease Course in Children With IBD

Sara Sila et al. Inflamm Bowel Dis. .

Abstract

Background: This study aimed to evaluate the effect of overweight and obesity at the start of anti-TNF therapy on treatment response and relapse rate in children with inflammatory bowel disease (IBD).

Methods: This multicenter, retrospective cohort study included 22 IBD centers in 14 countries. Children diagnosed with IBD in whom antitumor necrosis factor (anti-TNF) was introduced were included; those who were overweight/obese were compared with children who were well/undernourished.

Results: Six hundred thirty-seven children (370 [58%] males; mean age 11.5 ± 3.5 years) were included; 140 (22%) were in the overweight/obese group (OG) and 497 (78%) had BMI ≤1 SD (CG). The mean follow-up time was 141 ± 78 weeks (median 117 weeks). There was no difference in the loss of response (LOR) to anti-TNF between groups throughout the follow-up. However, children in OG had more dose escalations than controls. Male sex and lack of concomitant immunomodulators at the start of anti-TNF were risk factors associated with the LOR. There was no difference in the relapse rate in the first year after anti-TNF introduction; however, at the end of the follow-up, the relapse rate was significantly higher in the OG compared with CG (89 [64%] vs 218 [44%], respectively, P < .001). Univariate and multivariate analysis revealed that being overweight/obese, having UC, or being of male sex were factors associated with a higher risk for relapse.

Conclusions: Overweight/obese children with IBD were not at a higher risk of LOR to anti-TNF. Relapse in the first year after anti-TNF was introduced, but risk for relapse was increased at the end of follow-up.

Keywords: Crohn’s disease; adalimumab; infliximab; ulcerative colitis.

Plain language summary

Overweight and obese children with inflammatory bowel disease required more frequent dose escalations, but overall loss of response to anti-TNF therapy was not increased. Furthermore, in the long term, they tend to have a higher risk for relapse.

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