Higher doses anti-tumor necrosis factor-α (anti-TNF-α) therapy may be necessary for obese patients with ulcerative colitis (UC), according to the findings of a recently published meta-analysis. 

Although 15 to 40% of adults with inflammatory bowel disease (IBD) are obese, evidence surrounding the effect of obesity on anti-TNF treatment has been found to be inconsistent. To investigate the association, study authors searched MEDLINE, Web of Science, Google Scholar, ClinicalTrials.gov, and the Cochrane library for randomized controlled trials and observational cohort studies that assessed anti-TNF therapy efficacy in IBD patients and stratified patients based on either body mass index or body weight. 

Findings of the analysis revealed obesity to be associated with higher odds of anti-TNF treatment failure (odds ratio [OR], 1.195; 95% CI, 1.034-1.380; P =.015; I2 =47.8%). Subgroup analyses determined that, although obesity did not increase the odds of anti-TNF therapy failure in patients with Crohn disease (OR, 1.099; 95% CI, 0.928-1.300; P =.273; I2=54.1%), it did increase the odds of treatment failure in UC patients (OR, 1.413; 95% CI, 1.008-1.980; P =.045; I2 =20.0%). 

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Additionally, data analysis revealed that the odds of treatment failure was found to be significantly increased in obese patients receiving both fixed-dose (OR, 1.121; 95% CI, 1.027-1.224; P =.011) as well as weight-based anti-TNF agents (OR, 1.449; 95% CI, 1.006-2.087; P =.046).

“We propose that physicians may consider aggressive treatment and close trough level monitoring in obese patients treated with anti-TNF agents,” the authors concluded, adding that “A higher dose of anti-TNF agents in obese patients may be considered, but attention should be paid to prevention and treatment of adverse events.”


Dai, Z., Xu, X., & Ran, Z. (2020). Associations Between Obesity and the Effectiveness of Anti–Tumor Necrosis Factor-α Agents in Inflammatory Bowel Disease Patients: A Literature Review and Meta-analysis. Annals of Pharmacotherapy. doi.org/10.1177/1060028019900660.