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EULAR 2017 | Daily Highlights
IMPACT OF OBESITY ON THE RESPONSE TO TUMOUR NECROSIS FACTOR INHIBITORS IN AXIAL SPONDYLOARTHRITISAbstract: THU0347
Authors: R. Micheroli1,*, M. Hebeisen2, A. Scherrer2, L. Wildi1, P. Exer3, G. Tamborrini4, J. Bernhard5, B. Möller6, P. Zufferey7, M. J. Nissen8, A. Ciurea1
1University Hospital Zurich, 2SCQM, Zurich, 3Rheuma-Basel, 4UZR, Basel, 5Bürgerspital, Solothurn, 6Inselspital, Bern, 7CHUV, Lausanne, 8University Hospital Geneva, Geneva, Switzerland
Few studies have investigated the impact of obesity on response to tumour necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA).
To investigate the impact of different Body Mass Index (BMI) categories on TNFi response in a large cohort of patients with axSpA.
Patients within the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS criteria for axSpA, started a first TNFi after recruitement and had available BMI data as well as a baseline and follow-up visit at 1 year (±6mo) (N=632). Patients were categorized according to BMI: normal (BMI 18.5 to <25), overweight (BMI 25 to 30) and obese (BMI >30). We evaluated the proportion of patients achieving the 40% improvement 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 non-responders. We controlled for age, sex, HLA-B27, axSpA-type, BASDAI, BASMI, elevated CRP, current smoking and physical exercise in multiple adjusted logistic regression analyses.
In comparison to normal weight and overweight patients, obese individuals were significantly older, had a longer symptom duration and higher BASFI and BASMI levels, while ASDAS levels were comparable between the 3 groups (Table 1). Data to calculate the ASAS40 response was available in 496 patients (78%). It was reached by 44%, 35% and 28% of patients with normal weight, overweight and obesity, respectively, (p=0.02; Table 2). A significantly lower odds ratio (OR) for achieving ASAS40 response was found in adjusted analyses in obese patients vs patients with normal BMI (OR 0.30, 95% confidence interval (CI) 0.11-0.73, p=0.01). Comparable results were found for the other outcomes assessed. The respective adjusted ASAS40 OR in overweight vs. normal weight patients was 0.69, 95% CI 0.38-1.24, p=0.22.
Table 1. Baseline characteristics at start TNFi
Values are the %., *overall P value
Obesity is associated with significantly lower response rates to TNFi in patients with axSpA.
Previously presented at ACR 2016, to be presented at AAD 2017 and reproduced with permissions. This study was sponsored by Pfizer Inc. Editorial support was provided by AG McCluskey of CMC and was funded by Pfizer Inc.
Disclosure of Interest:
The study analyzed data from the SCQM cohort and represents the largest analysis on the effect of BMI on response to TNF inhibitors in axial spondyloarthritis to date, with 200 overweight and nearly 100 obese patients (BMI >30) treated with biologics. The results of logistic regression analyses adjusted for multiple confounders demonstrate slightly lower odds ratios for achieving different response outcomes in overweight patients. However, significantly lower response rates were reached in obese patients. The SCQM data indicate that underdosing might explain at least partially these findings, as crude ASAS40 responses were similar in patients with normal weight, overweight and obesity when treated in a weight-adjusted manner with infliximab, but not upon treatment with subcutaneous anti-TNF agents. A trend for better responses were also found in obese patients treated with infliximab in the multiple adjusted logistic regression analyses, although statistical significance was not reached in this setting. However, in the overall population, a trend for lower ASAS40 responses was demonstrated in patients treated with infliximab versus patients treated with other anti-TNF agents.
PD Dr. Adrian Ciurea