Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, Australia.
Department of Gastroenterology, Royal Perth Hospital, Perth, Australia.
Clin Transl Gastroenterol. 2024 Jul 1;15(7):e00722. doi: 10.14309/ctg.0000000000000722.
Anti-interleukin 12/23 agents have shown greater durability in response compared with anti-tumor necrosis factor α agents. Data on the association between body composition (BC) or body mass index (BMI) and ustekinumab's therapeutic response is limited. We aimed to evaluate the impact of BC on time to failing standard doses of ustekinumab in patients with Crohn's disease (CD).
Patients with CD aged 16 years and older from 2 tertiary centers were studied retrospectively. Included patients had abdominal imaging within 6 months of ustekinumab induction and were followed until April 30, 2022. An experienced abdominal radiologist blinded to the clinical information measured the area of visceral fat area and skeletal muscle area at the mid L3 vertebral level, with values corrected for height 2 to derive respective indices (visceral fat index [VFI], skeletal muscle index [SMI]) and the VFI:SMI ratio.
Ninety-nine patients met inclusion criteria. The mean age at ustekinumab induction was 46.6 (±1.6) years. The median BMI (interquartile range) was 26.5 (22.6-30.8). Twenty-four patients (24.2%) did not respond or lost response to standard doses of ustekinumab over the follow-up duration. A younger age (hazard ratio 0.96, 95% confidence interval 0.94-0.99, P = 0.01) and a VFI:SMI ratio >1.6 (hazard ratio 4.65, 95% confidence interval 1.73-12.45, P = 0.002) were both associated with a shorter time to failing ustekinumab at standard doses on multivariate analysis. BMI, notably, had no association with the primary outcome.
A high VFI:SMI ratio is associated with an increased risk of failing standard doses of ustekinumab. BC measurements derived from cross-sectional imaging at the start of ustekinumab therapy is a useful indicator for therapeutic durability.
与抗肿瘤坏死因子 α 药物相比，抗白细胞介素 12/23 药物在应答方面具有更高的持久性。关于身体成分 (BC) 或体重指数 (BMI) 与乌司奴单抗治疗反应之间的关联的数据有限。我们旨在评估 BC 对克罗恩病 (CD) 患者接受乌司奴单抗标准剂量治疗失败时间的影响。
本研究回顾性分析了来自 2 个三级中心的年龄在 16 岁及以上的 CD 患者。纳入的患者在乌司奴单抗诱导后 6 个月内进行腹部影像学检查，并随访至 2022 年 4 月 30 日。一位经验丰富的腹部放射科医生在不知道临床信息的情况下，在第 3 腰椎水平的中线测量内脏脂肪面积和骨骼肌面积，并根据身高进行校正，得出相应的指数（内脏脂肪指数 [VFI]、骨骼肌指数 [SMI]）和 VFI:SMI 比值。
99 例患者符合纳入标准。乌司奴单抗诱导时的平均年龄为 46.6（±1.6）岁。中位 BMI（四分位间距）为 26.5（22.6-30.8）。24 例（24.2%）患者在随访期间对标准剂量的乌司奴单抗无应答或失去应答。年龄较小（风险比 0.96，95%置信区间 0.94-0.99，P = 0.01）和 VFI:SMI 比值>1.6（风险比 4.65，95%置信区间 1.73-12.45，P = 0.002）在多变量分析中均与乌司奴单抗标准剂量治疗失败的时间较短相关。值得注意的是，BMI 与主要结局无关。
高 VFI:SMI 比值与乌司奴单抗标准剂量治疗失败的风险增加相关。乌司奴单抗治疗开始时的横断面成像得出的 BC 测量值是治疗持久性的有用指标。
