Loss of muscle mass (Sarcopenia) as a Predictor of Anti-TNF Response in Crohn’s disease
Project: Loss of muscle mass (Sarcopenia) as a Predictor of Anti-TNF Response in Crohn’s disease
Year: 2015 – IN PROGRESS
Researcher: Nik Ding, St Mark’s Hospital
Background: Recent studies have identified a correlation between increasing body mass index (BMI) and an increased rate of loss of response to anti-TNF therapy. Subsequently, dosing anti-TNF drugs at an adequate level is required for sustained and durable response. However, the use of BMI to make inferences about patients underlying body composition is inadequate, as weight may be comprised of peripheral fat or muscle. Measurement of an individual’s loss of muscle mass (sarcopenia) to assess body composition may subsequently be a more precise tool for predicting disease outcome and anti- TNF response, and is the focus of this study.
Aims: Approximately 70% of patients with Crohn’s disease will require surgery despite the use of biologic therapy and 10-15% lose response to the drug every year. We hope to be able to detect a body composition (i.e. sarcopenia) profile that predicts poor outcomes.
- To demonstrate that sarcopenia is associated with poor outcome (assessed by time to first operation or time to commencement of anti-TNF therapy).
- To demonstrate that sarcopenia is a biomarker of primary non-response (PNR) and secondary loss of response (SLR) to anti-TNF therapy.
This study hypothesises that patients with Crohn’s disease who have reduced muscle mass (sarcopenia) will have a greater risk of poor outcomes including the need for surgery and worsening disease course. We also propose that those undergoing anti-TNF therapy for Crohn’s disease with sarcopenia will be at greater risk of poor outcomes including loss of response or surgery at 3 years. On average, each patient receives at least two bowel imaging scans (MRI/CT) within the first year of their disease course and more thereafter.
The anticipated outcomes are driven toward improving quality of life and outcomes for patients. Little is currently known about sarcopenia and its relation to Crohn’s disease. Health professionals are acutely aware of the importance of diet and weight on outcome measures. However the use of weight alone without consideration to the degree of muscle mass in the body’s composition, limits it’s capacity to predict outcomes.
Nutrition is integral for chronic diseases particularly those affecting the gastrointestinal tract such as Crohn’s disease. Enteral nutrition is widely used in paediatric populations as a steroid-sparing agent for induction of remission and maintenance therapy. In an adult population, we seek to make this correlation clearer by studying patient’s muscle mass using CT or MRI cross-sectional imaging which is readily available at most hospital services.
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