P1642 - A Comparison of Weight Gain in Patients With Inflammatory Bowel Disease Treated With TNF-alpha Inhibitors, Vedolizumab or Ustekinumab

Oliver Stewart, MD¹, Arielle Leben, MS, RD¹, Jordan Axelrad, MD, MPH^2
1New York University Langone Medical Center, New York, NY; ²New York University School of Medicine, New York, NY

Introduction: Inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, are characterized by chronic inflammation of the gastrointestinal tract. Chronic inflammation and subsequent diarrhea are known to contribute to micronutrient deficiencies, bone loss, weight loss, and growth failure in children. Several medications currently used to treat IBD are hypothesized to lead to weight gain. TNF-alpha inhibitors, in particular, have been implicated in weight gain in adults with rheumatic conditions and children with IBD. The purpose of this study is to compare the degree of weight change in patients with IBD treated with TNF-alpha inhibitors, vedolizumab, or ustekinumab.

Methods: We performed a retrospective study of 49 patients with IBD initiating treatment with a TNF-alpha inhibitor (infliximab, adalimumab), vedolizumab, or ustekinumab. Patient weight, in addition to measures of disease activity, was monitored at 0, 6, 12, 18, and 24 month intervals. Medication responders were defined as those who demonstrated >3 point decrease in Harvey Bradshaw Index (HBI) or >1 point decrease in partial Mayo Score (pMayo). ANOVA testing was utilized to compare weight change between groups.

Results: We identified 49 patients with IBD initiated on a TNF-alpha inhibitor (n=21), vedolizumab (n=16), or ustekinumab (n=12). Baseline disease activity was similar between groups, with a mean HBI of 6.3, 7.6, and 7.7 and a mean baseline pMayo of 4.3, 5.3, and 3.5 in the TNF-alpha, ustekinumab and vedolizumab groups, respectively. There was an increased mean weight gain in the TNF-alpha inhibitor (5.2kg) and ustekinumab (4.0kg) groups compared to the vedolizumab group (1.8kg) at 12 months, although this did not reach statistical significance (F(2,46)=1.77, p=0.18). The weight gain trend continued at 24 months, with mean weight gain of 6.0kg, 6.1kg, and 2.5kg in the TNF-alpha inhibitor, ustekinumab, and vedolizumab groups, respectively (Figure 1). Medication responders gained more weight on average at 12 months compared to non-responders (4.7kg vs 0.9kg, p=0.02)

Discussion: Patients receiving TNF-alpha inhibitors and ustekinumab gained numerically more weight on average than patients receiving vedolizumab. In addition, medication responders gained significantly more weight on average compared to non-responders. As weight loss and nutritional deficiencies are common in IBD, weight gain profiles of the most common biologic agents are increasingly valuable.


Figure: Weight gain following treatment with a biologic at 12 months (a) and 24 months (b)

	TNF-alpha	Vedolizumab	Ustekinumab
Number of Patients	21	16	12
Age at Medication Initiation (yrs)	45.9	52.6	53.8
Sex, n (%) Male Female	13 (61.9) 8 (38.1)	9 (56.3) 7 (43.7)	6 (50.0) 6 (50.0)
Race, n (%) White (non-Hispanic/Latino) Black/African-American Hispanic/Latino Asian/Pacific Islander	16 (76.2) 0 (0) 4 (19.0) 1 (4.8)	15 (93.8) 1 (6.2) 0 (0) 0 (0)	11 (91.7) 1 (8.3) 0 (0) 0 (0)
Baseline Weight (kg)	71.4	70.2	76.4
History of IBD Surgery, n (%) Yes No	8 (38.1) 13 (61.9)	3 (18.8) 13 (81.2)	5 (41.7) 7 (58.3)
Charlson Comorbidity Index at Medication Initiation	1.3	1.8	1.8
IBD Diagnosis, n (%) Crohn's disease Ulcerative Colitis	17 (81.0) 4 (19.0)	3 (18.8) 13 (81.2)	9 (75.0) 3 (25.0)
Age at IBD Diagnosis (yrs)	34.4	39.9	39.3
Partial Mayo Score at Medication Initiation (Ulcerative Colitis)	4.3	3.5	5.3
Harvey Bradshaw Index at Medication Initiation (Crohn's disease)	6.3	7.7	7.6
Smoking Status, n (%) Current Former Never	1 (4.8) 8 (38.1) 12 (57.1)	1 (6.3) 4 (25.0) 11 (68.7)	0 (0) 2 (16.7) 10 (83.3)

Table: Characteristics of Study Population


Disclosures:
Oliver Stewart indicated no relevant financial relationships.
Arielle Leben indicated no relevant financial relationships.
Jordan Axelrad: Abbvie – Advisory Committee/Board Member. BioFire Diagnostics – Consultant, Grant/Research Support. Janssen – Consultant.


Oliver Stewart, MD¹, Arielle Leben, MS, RD¹, Jordan Axelrad, MD, MPH². P1642 - A Comparison of Weight Gain in Patients With Inflammatory Bowel Disease Treated With TNF-alpha Inhibitors, Vedolizumab or Ustekinumab, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.