Body mass index and response to tocilizumab in rheumatoid arthritis: a real life study

Abstract

Several studies have suggested that obesity could have a negative effect on response to anti-tumor necrosis factor α (anti-TNFα) in rheumatoid arthritis (RA). Little is known about the impact of body mass index (BMI) on other biologic agents. We aimed to evaluate the effect of BMI on response to tocilizumab (TCZ) in RA. RA patients treated with TCZ were included in this multicenter retrospective study. BMI was calculated at the initiation of treatment. After 6 months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, and tender and swollen joints were analyzed. The primary endpoint was decrease in DAS28 ≥ 1.2. Secondary outcomes were good response and remission by EULAR criteria. At baseline, among 115 RA patients included, the median (interquartile range) BMI was 25.4 (22.0-28.8) kg/m(2). The number of patients with normal weight, overweight, and obesity was 53 (46 %), 37 (32 %), and 25 (22 %), respectively. Baseline characteristics did not differ between the three subgroups of BMI. The median BMI did not differ between responders and non-responders for DAS28 decrease ≥1.2 (25.7 [22.1-29.9] vs 24.9 [22.0-27.1], P = 0.38), EULAR good response (25.9 [22.8-30.0] vs 25.4 [22.0-28.4], P = 0.61), and remission (25.1 [22.5-28.6] vs 25.4 [22.0-28.9], P = 0.76). BMI did not affect the response to TCZ in RA. If confirmed, these results could be helpful for the selection of a biologic agent in obese RA patients.

Body mass index and response to abatacept in rheumatoid arthritis

“…A negative association was found between BMI and response to anti‐TNFα therapies, notably infliximab, in RA , psoriatic arthritis and ankylosing spondylitis , which suggests that fat mass may affect the response to biologic agents. Conversely, two recent studies showed that response to TCZ in patients with RA was not affected by baseline BMI . We focused on the relationship between BMI and response to ABA in RA treatment and found no association of increased BMI and low response to ABA.…”

A systematic review of the association of obesity with the outcomes of inflammatory rheumatic diseases

“…(68) We found that the studies involving TNF-α inhibitors were associated with different outcomes: four studies (2,10,16,17) were associated with positive outcomes, three studies (25,26,29) with neutral outcomes and ten studies (11,(32)(33)(34)40,55,56,61,62,65) with negative outcomes. Rituximab was associated with positive, (17) neutral (23) and negative (11,56) outcomes, while tocilizumab was similarly associated with positive, (15) neutral (22,27) and negative (11,56) outcomes. Due to the limited number of studies for tocilizumab, we conducted an additional literature search on it and found that tocilizumab is unlikely to be affected by obesity.…”

“…A total of 11 studies with 3,834 subjects showed that obesity was neither associated with better nor worse outcomes, with insignificant associations reported (Table II). (6,8,(22)(23)(24)(25)(26)(27)(28)(29)(30) Most of the studies investigated the RA disease population. For PsA and axial SpA (AxSpA), one study was found for each disease population.…”

Prediction of Response to Targeted Treatment in Rheumatoid Arthritis

“…43 There is no evidence for an effect of BMI on response to tocilizumab treatment in RA. 69,70 One study of 204 patients with RA could not find an effect of current smoking on EULAR response after 24 weeks of tocilizumab treatment. 43 PREDICTORS OF RESPONSE TO ABATACEPT TREATMENT There are only a few studies exploring biomarkers predictive of response to abatacept.…”