Body weight, gender and response to TNF-  blockers in axial spondyloarthritis

Abstract

Data suggest that being female, overweight and mostly obese is associated with a lower rate of success in obtaining response status in axial SpA patients treated with anti-TNF drugs. Body weight could represent a modifiable factor to reach the best outcome in axial SpA patients treated with TNF blockers.

Body Mass Index and response to rituximab in rheumatoid arthritis

“…Obesity might be a risk factor of RA developing from undifferentiated arthritis [29] and is associated with decreased radiographic evidence of disease progression in RA [10]. Recent reports showed a negative association between BMI and response to anti-TNF␣ therapies, notably IFX, in RA [13][14][15], psoriatic arthritis [16,17] and AS [18,19], which suggests that fat mass may affect the response to biologic agents. Here, we investigated whether BMI could affect the response to RTX among RA patients.…”

“…Recent reports showed a negative association between BMI and response to anti-TNF␣ therapies, notably infliximab (IFX), in RA [13][14][15], psoriatic arthritis [16,17] and ankylosing spondylitis (AS) [18,19], which suggests that fat mass may affect the response to biologic agents. BMI might be a predictive factor of IFX response in RA, but no study has evaluated the impact of BMI on rituximab (RTX) response in RA.…”

The Impact of Body Mass Index on Disease Progression in Ankylosing Spondylitis

“…Indeed, the WHO reported that, as a group, the obese and overweight adult population is now approaching 40% of the world's population, with rates in the US now at~66% (Maffetone et al, 2017). The excess of adipose tissue in overweight and obese individuals (routinely expressed by BMI) may have immunodulating properties affecting the course of the disease (Gremese et al, 2014). An increase in adipose tissue, which is considered a dynamic endocrine organ, is associated with increased production of several proinflammatory cytokines (Vargas et al, 2016).…”

Adipose-Tissue and Intestinal Inflammation – Visceral Obesity and Creeping Fat

“…Additionally, high concentrations of circulating pro-inflammatory molecules also altering the therapeutic effect led to the conclusion, which weight-adjusted anti-TNF therapy should be favored in obese patients (136). Using this approach for infliximab treatment did not overcome the shorter time to loss of response in obese IBD patients compared to lean controls, suggesting that weight-adjusted therapy alone is not sufficient (137); a phenomenon also observed in obese spondyloarthritis patients receiving weight-adjusted infliximab therapy (138). …”