The Effect of TNF and Non-TNF-Targeted Biologics on Body Composition in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is associated with a decrease in lean mass and stability or even an increase in fat and ectopic adipose tissue. A few data are available on body composition changes under treatment, and data are still controversial. Body composition was assessed before initiation of biologic disease-modifying antirheumatic drug (bDMARD) and after 6 and 12 months of stable treatment. Eighty-three RA patients were included (75% of women, mean age 58.5 ± 10.8 years) of whom 47 patients treated with TNF inhibitor (TNFi), 18 with non-TNF-targeted biologic (Non-TNFi), and 18 with conventional DMARD (cDMARD) alone. In the TNFi group, total lean mass, fat-free mass index, and skeletal muscle mass index significantly increased at 1 year. An increase in subcutaneous adipose tissue (SAT) without change for the visceral or body fat composition was associated. These changes were associated with an improvement in strength and walking test. In non-TNFi or cDMARD groups, no significant changes for body composition or muscle function were observed at 1 year. However, no significant differences for treatment x time interaction were noted between group treatments. In active RA patients starting first bDMARD, treatment with TNFi over 1 year was associated with favorable changes of the body composition and muscle function.

The effect of disease-modifying anti-rheumatic drugs on skeletal muscle mass in rheumatoid arthritis patients: a systematic review with meta-analysis

“…After this process, 32 articles were included for the full-text screening. Finally, after the full-text reading, we included nine studies: Engvall et al [ 41 ] and Marcora et al [ 42 ] as randomized clinical trials and Al Khayyad et al [ 43 ], Vial et al [ 44 ], Tournadre et al [ 45 ], Toussirot et al [ 46 ], Ferraz-Amaro et al [ 47 ], Metsios et al [ 48 ], and Chikugo et al [ 34 ] as observational studies. The search and inclusion/exclusion criteria are described in Fig.…”

“…Of the nine studies included, four of them were performed in France [ 42 , 44 – 46 ], one of them in the UK [ 48 ], one in Spain [ 47 ], one in Japan [ 34 ], one in Sweden [ 41 ], and one in Italy [ 43 ]. Studies included were published between 2007 and 2020.…”

“…Among the nine papers included, the treatments used in the studies were tocilizumab [ 45 , 46 ], anti-TNF [ 47 , 48 ], JAKi [ 34 ], rituximab [ 43 ], bDMARDs [ 44 ], etanercept [ 42 ], methotrexate [ 41 , 42 ], sulfasalazine [ 41 ], and hydroxychloroquine [ 41 ].…”

Body composition in patients with rheumatoid arthritis: a narrative literature review

“…no significant changes in body composition) were reported with TNFα inhibitors in three small prospective studies ( n = 8–20) with various follow-up intervals (12 weeks to 2 years) and without control groups. 18 , 100 , 101 On the other hand, in a 1-year open follow-up study involving 83 RA patients (75% women; mean age 58.5 years; median disease duration 3.7 years), Tournadre et al 104 found significant changes in lean mass parameters in patients treated with TNFα inhibitors. In that study, the body composition parameters of 47 bDMARDs-naïve patients (mainly etanercept, n = 35) with active RA were compared with those of patients treated with csDMARDs alone ( n = 18) or with non-TNFα inhibitor bDMARDs ( n = 18 including 2 with tocilizumab, 10 with rituximab and 6 with abatacept).…”

“…No change in body composition was observed at 12 months in patients treated with non-TNFα inhibitor bDMARDs or csDMARDs. 104 However, due to the lack of randomisation and the small sample size of the controls, no definitive conclusions can be drawn. Moreover, 45% of patients were on steroids (median dose 6.5 mg/day) with a heterogeneous distribution between the groups (72.2% in the non-TNF inhibitor bDMARDs group versus 38.3% in the TNF inhibitor groups versus 33.3% in the csDMARDs group).…”