P365 Weight gain after initiation of adalimumab in patients with Crohn’s disease

Abstract

Abstract Background Overweight and obesity are associated with increased risk of metabolic chronic diseases including cardiovascular disease and metabolic associated fatty liver disease. Weight gain post initiation of anti-tumour necrosis factor-alpha (TNFα) inhibitor medication is anecdotally common. This project aimed to determine whether weight gain occurs after inititiation of anti-TNFα inhibitor adalimumab. Methods A hospital database of, 277 patients that started on adalimumab between November, 2015 and November, 2020 to manage Crohn’s disease was retrospectively audited. Demographic and clinical data were extracted from the electronic medical record of patients. Weight and height prior to, and after, initiation of adalimumab were recorded and body mass index (BMI) was calculated. Anthropometric data was analysed using paired t-tests and statistical significance was assumed at p<0.05. Results Patients initiated on adalimumab were mostly of New Zealand European ethnicity, 216/277 (78%), 159/277 (56%) were female, 129/277 (47%) had ileocolonic Crohn’s disease and, 199/277 (72%) had non-stricturing, non-penetrating disease. Weight before and after starting adalimumab was available for, 160/277 (58%) patients and increased by a mean of, 3.19 ±, 7.62% from, 74.74 ±, 18.98 kg to, 76.91 ±, 19.53 kg (2.18 kg (95% CI:, 1.31 to, 3.06, p < 0.0001). Height (cm) was documented in, 97 (35%) patients. Mean BMI pre-adalimumab was, 25.89 kg/m2 (range, 16.05 to, 45.94 kg/m2) and increased by a mean of, 0.74 kg/m2 (95% CI:, 0.34 to, 1.13, p < 0.001). Post-initiation of adalimumab patients with a BMI <, 18.5 kg/m2 fell from five to three (3.1%) patients and the number of patients with a BMI ≥, 30.0 kg/m2 increased from, 18 to, 21 (21.6%) patients. Conclusion This single centre audit of patients starting adalimumab for management of Crohn’s disease found that significant weight gain is common. Less than two thirds of patients had weight documented at follow up appointments and height was documented in approximately a third of patients. Interventions to limit unintentional weight gain on initiation of adalimumab are warranted.