The impact of sex on the efficacy of anti-TNF-α therapy in Crohn’s disease patients with different visceral adipose tissue levels

Sex, location, and visceral adipose tissue (VAT) influence the course of Crohn’s disease (CD). However, the combined impact of these factors has not been consistently or thoroughly considered in anti-tumour necrosis factor-α (anti-TNF-α) therapy. This study aims to investigate how sex, location, and VAT levels affect the efficacy of IFX treatment in CD patients. This retrospective multicenter study included 182 CD patients (120 males and 62 females) who received IFX therapy between January 2014 and January 2024. There was a statistically significant difference in remission rates between male visceral obesity group (M-VATH) and male non-visceral obesity group (M-VATL) at 6 months (p < 0.001) and 12 months (p < 0.001). Similar differences in remission rates were observed between the male colon-uninvolved visceral obesity group and the male colon-uninvolved non-visceral obesity group at 6 months (p < 0.001) and 12 months (p < 0.001). Additionally, serum TNF-α concentrations (p = 0.010)and IFX trough concentrations (p = 0.003) showed significant differences between M-VATH and M-VATL. The VAT area was identified as a predictor of IFX efficacy in male patients, with an area under the receiver operating characteristic curve of 0.813, sensitivity of 73.9%, and specificity of 78.1% (95% CI, 0.730–0.896). Sex and location influence the predictive function of VAT for IFX efficacy. VAT may be an accurate predictor of IFX efficacy in male colon-uninvolved CD patients.