Mesenteric adipose tissue volume predicts response to antitumor necrosis factor therapy in biological-naïve Crohn’s disease patients

Introduction: Crohn´s disease is associated with varying degrees of mesenteric adipose tissue (MAT) hypertrophy. The study aimed to evaluate whether MAT hypertrophy, measured by MAT volume, is associated with worse response to anti-TNF-α therapy in biologic-naïve CD patients. Methods: A cohort of consecutive CD patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) before the start of the anti-TNF-α therapy was included. Total MAT volume, excluding large vessels, was estimated. Primary outcomes - dose intensification, surgery, and withdrawal of anti-TNF-α therapy - were evaluated at 3 and 12 months after the initiation of treatment. We performed a multivariate logistic regression model to identify MAT volume as an independent risk factor for poor response to anti-TNF-α. Results: 50 biologic-naïve, consecutive CD patients were included. The median MAT volume was 559.5 cm 3 (IQR: 410.3-891.9). MAT volume was positively correlated with weight (ρ = 0.66, p < 0.001) and age (ρ = 0.5, p < 0.001). Multivariate regression model showed that higher MAT volume independently predicted a poor response to anti-TNF-α treatment, as indicated by a greater need for dose intensification of anti-TNF-α agents within 12 months (adjusted odds ratio (OR a ): 1.36; 95% CI: 1.08-1.81; p = 0.016) and an increased risk of CD surgery within 3 months (OR a : 1.65; 95% CI: 1.08–3.05; p = 0.048). Conclusions: MAT volume predicted an increased need for anti-TNF-α dose intensification and surgery in biological-naïve Crohn’s disease. MAT volume could be a valuable measure for identifying patients at risk of a poor anti-TNF-α response.