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TOPLINE:

Obesity was associated with lower odds of steroid-free clinical remission in patients with inflammatory bowel disease (IBD) at week 24 after the initiation of treatment.

METHODOLOGY:

• Researchers analysed data from the Initiative on Crohn and Colitis registry to assess the effect of obesity on treatment response in patients with IBD.
• They included 1066 patients (median age, 42 years; 56.3% women) with IBD who started various treatments, including thiopurines with allopurinol, intravenous/subcutaneous vedolizumab, ustekinumab, ozanimod, filgotinib, or tofacitinib.
• Of 1066 patients, 616 had Crohn's disease, 432 had ulcerative colitis, and 18 had IBD-unclassified.
• Body mass index (BMI) was documented at baseline, and patients were categorised on the basis of their BMI as those with normal weight (< 25; n = 619), overweight (≥ 25 and < 30; n = 303), and obesity (≥ 30; n = 144), and remission rates were compared among these categories.
• The primary outcome was steroid-free clinical remission at week 24 after treatment initiation, defined as a Simple Clinical Colitis Activity Index ≤ 2 for ulcerative colitis and IBD-unclassified and a Harvey-Bradshaw Index < 5 for Crohn's disease.

TAKEAWAY:

• Patients with obesity achieved lower steroid-free clinical remission rates at week 24 than those with normal weight (35.3% vs 48.6%).
• Obesity was associated with lower odds of steroid-free clinical remission at week 24 (adjusted odds ratio [aOR], 0.537; P = .005).
• At week 12, overweight was associated with higher odds of steroid-free clinical remission (aOR, 1.369; P = .043). At week 52, steroid-free clinical remission rates were comparable among patients with normal weight, overweight, and obesity.
• No significant differences in treatment discontinuation rates were observed among BMI groups at weeks 12, 24, and 52.

IN PRACTICE:

"In clinical practice, it is important to discuss body weight and raise awareness of its impact on overall health and treatment outcomes in IBD, while providing guidance to support healthy weight management using nutritional counselling and lifestyle interventions," the authors wrote.

SOURCE:

This study, led by Dorien Oomkens, Radboud University Medical Centre, Nijmegen, the Netherlands, was published online on April 16, 2025, in Digestive Diseases and Sciences.

LIMITATIONS:

The absence of data regarding lifestyle, diet, and exercise habits may have influenced response rates. The registry excluded anti–tumour necrosis factor agents and methotrexate as it focused on novel treatments, and follow-up data on upadacitinib were limited. The relatively short-term assessment of response rates may have limited the understanding of persistent remission.

DISCLOSURES:

This study did not receive any specific funding. Some authors reported being speakers and/or advisory board members, receiving grants, and having other financial ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.