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Higher BMI Associated With Risk of Discontinuation for Non–TNF-Targeted Therapy for Rheumatoid Arthritis
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Key Takeaways
- Obesity in RA patients correlates with poorer clinical response and higher discontinuation rates for non-TNF-targeted treatments.
- Obese RA patients exhibit higher swollen joint counts and lower treatment continuation rates compared to those with normal or lower BMI.
Patients with rheumatoid arthritis and higher body mass index (BMI) showed poorer clinical response to non-tumor necrosis factor (TNF)-targeted treatments.
Patients with rheumatoid arthritis (RA) and higher body mass index (BMI) showed poorer clinical response and higher discontinuation rates for non-tumor necrosis factor (TNF)-targeted treatments, according to the authors of a study published in Therapeutic Advances in Musculoskeletal Disease.1
Rheumatoid Arthritis, Obesity, BMI, Therapy | Image Credit: © yodiyim | stock.adobe.com
In an article in Current Rheumatology Reports, Poudel et al state that obesity can be associated with more severe symptoms and higher rates of disability for patients with RA. The authors note that obesity is associated with an inflammatory state, which could contribute to the development of systemic inflammatory conditions. The presence of obesity can also have impacts on patient symptoms and outcomes; however, the authors found via imaging and lower rates of radiographic progression that those with obesity and RA have less inflammation. Further, there has not been evidence on the effectiveness of specific therapies and associations with obesity.2
Investigators in the current study used data from the Korean nationwide biologics and targeted therapy registry to evaluate the association of BMI and effectiveness of non–TNF-targeted treatment for patients with RA, specifically in clinical response and drug discontinuation rate within 1 year. Individuals included were diagnosed by rheumatologists and fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria. The primary outcome included whether obesity influenced the discontinuation rates of non–TNF-targeted disease-modifying anti-rheumatic drugs (DMARDs) and other outcomes included the proportion of patients that continued targeted treatment at 1 year, disease activity at 1 year, change in disease activity score (DAS28-ESR) and C-reactive protein (CRP) score at 1 year, and proportion of patients achieving DAS28-ESR remission at 1 year.1
A total of 2356 patients were enrolled, receiving either biologic DMARDs or targeted-systemic DMARDs between December 2013 and November 2020. After exclusion, including those who switched treatment for the first time or more, those receiving TNF inhibitors as their first therapy, and missing follow-up data or data uncertainty were excluded. A total of 602 were included in the final analysis. The mean age was 49.7 years, 80.9% were women, and 3.65% had a BMI of 30 kg/m2 or greater. The continuation rate for targeted treatment at the 1-year follow-up was significantly lower in the obese group at 81.8% compared with normal or lower BMI at 93.8% and overweight group at 89%. The swollen joint counter was significantly higher in the obese BMI group at 3.09 compared with 1.30 and 1.42 in the normal/lower BMI group and overweight BMI group, respectively.1
The change in DAS28-ESR score from baseline to 1 year was significantly lower for those in the obese group at 2.06 compared with the normal/low group at 2.76. However, the clinical parameters at 1 year, including tender joints count, DAS28-CRP, CRP, and proportion of patients achieving remission did not differ among the 3 groups. In another analysis, the treatment duration was significantly shorter in the obese group compared to the normal/lower and overweight groups, but reason for treatment discontinuation was not statistically different among the groups. Furthermore, in a multivariable Cox proportional hazards analysis, investigators found that the obese group had a higher risk of discontinuation compared with the normal/lower group after adjusting for baseline demographics and other variables.1
