Does intestinal ultrasound combined with visceral adipose tissue more accurately predict primary non-response to infliximab in patients with Crohn’s disease? A prospective, observational study

Background: Infliximab (IFX) is widely used for the treatment of Crohn’s disease (CD), yet up to 40% patients experience primary non-response (PNR). Visceral adipose tissue (VAT) and intestinal ultrasound (IUS) could be used as noninvasive tools to predict treatment efficacy with limited value, respectively. Objectives: This study aims to investigate the value of IUS combined with VAT in predicting PNR in CD patients. Design: This was a single-center, prospective, and observational study. Methods: Consecutive patients with active CD initiating regular IFX therapy were prospectively included. Patients underwent IUS at baseline (T0), week 2–4 (T1), and week 14 (T2), and CT at T0 to collected visceral fat area (VFA). Multivariable analyses and logistic regression analysis were used to identify predictors based on the efficacy at T2, regardless of prior biologic exposure. Results: Of 100 patients, 31 (31%) experienced PNR. Multivariable analysis identified baseline bowel wall thickness [BWT T0; odds ratio (OR), 2.082; 95% confidence interval (CI), 1.038–4.176; p < 0.05], VFA (VFA T0; OR, 1.030; 95% CI, 1.008–1.052; p < 0.01), the decrease of BWT (△BWT; OR, 2.717; 95% CI, 1.349–5.472; p < 0.01) and the International Bowel Ultrasound Segmental Activity Score (△IBUS-SAS; OR, 1.082; 95% CI, 1.007–1.163; p < 0.05) from baseline to T1 were independent predictors of PNR. The △BWT combined with VFA T0 can accurately predict PNR with a receiver operating characteristic (ROC) of 0.841 (95% CI, 0.756–0.926), superior to BWT T0 combined with VFA T0 (ROC, 0.832; 95% CI, 0.754–0.909) and △IBUS-SAS combined with VFA T0 (ROC, 0.830; 95% CI, 0.753–0.917). Conclusion: Early change in BWT on IUS combined with baseline VFA is highly predictive of PNR to IFX in CD patients, allowing stratification of patients beneficial from treatment initiation and guiding individualized clinical practice.