The composition and mass of our bodies can dramatically influence how drugs are absorbed and metabolized, recent Cedars-Sinai research in Los Angeles revealed, discovering that patients with inflammatory bowel disease (IBD) having greater amounts of intra-abdominal visceral adipose tissue—a unique form of fat within the abdomen—experienced less remission when they were treated with some anti-inflammatory drugs.
The study was published in the journal Gastroenterology.
“Although biologic drugs have greatly enhanced outcomes in our patients with Crohn’s disease orulcerative colitis, some individuals respond poorly to these treatments. In our analysis, we discovered that the patients with greater levels of internal abdominal fat were less likely to get better and enter remission from their illness,” said gastroenterologist Andres Yarur, MD, lead author of the study.
In contrast to some traditional anti-inflammatory medications that act against inflammation in a non-selective manner, biologics target certain causes of inflammation in the body by blocking them.
Higher levels of visceral fat in study patients were associated with lower blood levels of the biologic drugs following treatment, as well as reduced rates of steroid-free remission and healing of the bowel.
It is possibly not body mass or body mass index [BMI] that underlies why some of our patients respond to these approved biologic drugs. We think the fat tissue on the inside of the abdomen, in general, influences treatment, so we might need to give greater doses of the medications to assist these patients,” said Gil Melmed, MD, a co-author of the study and director of Inflammatory Bowel Disease Clinical Research at Cedars-Sinai.
Researchers treated 141 IBD patients with either one of three biological drugs: infliximab, ustekinumab, or vedolizumab. Accurate measurements of body composition were obtained in both the IBD group and the 51 healthy controls so that fat composition for the two groups would be comparable.
“We found that higher visceral adiposity was associated with higher levels of pro-inflammatory cytokines, suggesting that fat tissue promotes inflammation, the opposite of what we want, and increases resistance to biologic drug therapy. More research is needed because we don’t know whether lowering visceral fat or giving higher doses of the medications would improve drug efficacy,” said Melmed.
Yarur, the lead researcher of the study, concurs, noting that another type of medication might prove more beneficial to patients with greater intra-abdominal visceral fat.
Gastrointestinal disorders comprise a broad variety of conditions impacting the gastrointestinal system, resulting in a variety of symptoms. Frequent gastrointestinal disorders symptoms are pain in the abdomen, bloating, diarrhea, constipation, nausea, vomiting, and bowel habit changes. These symptoms may result from diseases such as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), celiac disease, and gastritis, among others. Although some symptoms are light and transient, others can have a drastic impact on day-to-day life and need medical intervention. Recognizing and knowing these digestive disorders symptoms are essential for early detection and management of digestive disorders.
“We would like to explore other drugs with different mechanisms of action, particularly other small molecules, and determine if our observations are true. With the prevalence of obesity and metabolic syndrome on the rise in our patient population, we would like to identify interventions that would change the body composition of these IBD patients who are not presently benefiting from these biologic therapies,” Yarur said.