Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis

Abstract

BackgroundFew studies have investigated the impact of obesity on the response to tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA). The aim of our study was to investigate the impact of different body mass index (BMI) categories on TNFi response in a large cohort of patients with axSpA.MethodsPatients with axSpA within the Swiss Clinical Quality Management (SCQM) program were included in the current study if they fulfilled the Assessment in Spondyloarthritis International Society (ASAS) criteria for axSpA, started a first TNFi after recruitment, and had available BMI data as well as a baseline and follow-up visit at 1 year (±6 months). Patients were categorized according to BMI: normal (BMI 18.5 to <25), overweight (BMI 25–30), and obese (BMI >30). We evaluated the proportion of patients achieving the 40% improvement in ASAS criteria (ASAS40), as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued the TNFi were considered nonresponders. We controlled for age, sex, HLA-B27, axSpA type, BASDAI, BASMI, elevated C-reactive protein (CRP), current smoking, enthesitis, physical exercise, and co-medication with disease-modifying antirheumatic drugs, as well as with nonsteroidal anti-inflammatory drugs in multiple adjusted logistic regression analyses.ResultsA total of 624 axSpA patients starting a first TNFi were considered in the current study (332 patients of normal weight, 204 patients with overweight, and 88 obese patients). Obese individuals were older, had higher BASDAI levels, and had a more important impairment of physical function in comparison to patients of normal weight, while ASDAS and CRP levels were comparable between the three BMI groups. An ASAS40 response was reached by 44%, 34%, and 29% of patients of normal weight, overweight, and obesity, respectively (overall p = 0.02). Significantly lower odds ratios (ORs) for achieving ASAS40 response were found in adjusted analyses in obese patients versus patients with normal BMI (OR 0.27, 95% confidence interval (CI) 0.09–0.70). The respective adjusted ASAS40 OR in overweight versus normal weight patients was 0.62 (95% CI 0.24–1.14). Comparable results were found for the other outcomes assessed.ConclusionsObesity is associated with significantly lower response rates to TNFi in patients with axSpA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1372-3) contains supplementary material, which is available to authorized users.

Efficacy and safety of secukinumab in Japanese patients with active ankylosing spondylitis: 24-week results from an open-label phase 3 study (MEASURE 2-J)

“…A similar tendency toward higher efficacy was observed in Asian patients who participated in the global secukinumab AS studies [29]. It has been reported that obesity negatively affects the outcome of axial SpA patients treated with anti-TNF agents [30] and secukinumab clearance and volume of distribution vary with body weight [31]; therefore, in addition to the design of open-label study, the overall lighter patient weights in MEASURE 2-J could have contributed to the positive treatment outcome. In this study, ASAS responses were higher in the subgroup of patients with body weight less than 70kg than in the 70-90 kg subgroup.…”

Baricitinib in Patients with Rheumatoid Arthritis and an Inadequate Response to Conventional Disease-Modifying Antirheumatic Drugs in United States and Rest of World: A Subset Analysis

“…Published literature has demonstrated that high BMI/obesity may negatively impact the response to TNF inhibitors [23][24][25] and that the presence of baseline autoantibodies and autoantibody levels have been correlated with clinical responses. In the AMPLE trial, baseline ACPA positivity (versus ACPA negativity) as measured by an anti-CCP2 ELISA was associated with better responses to abatacept or adalimumab; patients with the highest baseline ACPA antibody concentrations had better clinical response to abatacept than patients with AE adverse event, N population size, n number in group, QD daily, ROW rest of the world, SAE serious adverse event, US United States including Puerto Rico a Includes data up to rescue.…”

Trabecular Bone Score and Bone Density in Patients With Non-radiographic Axial Spondyloarthritis

“…Micheroli et al concluded that BMI affects response to TNFis in axSpA patients, in that study, results demonstrated that obesity was associated with signi cantly lower response to the aforementioned class of therapeutic agents [24]. Moreover, a French study conducted by Malochet-Guinamand et al found that axSpA patients with lower BMI had lower BMD [25].…”