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Obesity and response to biological therapy in rheumatoid arthritis: the role of body mass index and adipose tissue cytokines
M. Novella-Navarro1, F. Genre2, B. Hernández-Breijo3, S. Remuzgo-Martínez4, A. Martínez-Feito5, D. Peiteado6, I. Monjo7, M.Á. González-Gay8, C. Plasencia-Rodríguez9, A. Balsa10
- Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain. mnovellanavarro@gmail.com
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IdiPAZ, Madrid, Spain.
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IdiPAZ, Madrid, Spain.
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain.
- Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.
- Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.
CER15078
2022 Vol.40, N°9
PI 1726, PF 1732
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PMID: 35084302 [PubMed]
Received: 17/08/2021
Accepted : 25/10/2021
In Press: 12/01/2022
Published: 20/09/2022
Abstract
OBJECTIVES:
To analyse the role of body mass index (BMI) in the clinical response to biologic dis-ease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). To per-form an in-depth analysis of the pathophysiology of obesity by assessing serum adipokine levels and their potential changes according to treatment.
METHODS:
This study involved 105 patients with RA starting tumour necrosis factor inhibitors (TNFi) or tocilizumab (TCZ). Patients were classified ac-cording to BMI as normal-weight and overweight/obesity. The clinical response to treatment was as-sessed by Clinical Disease Activity Index (CDAI) 6 months after initiation of bDMARDs. Serum adi-pokines (leptin and adiponectin) were determined using a commercial immunoassay kit in samples ob-tained before initiation of bDMARDs and after 6 months of treatment.
RESULTS:
A correlation was observed between BMI and disease activity and between BMI and serum adipokines. Sixty percent of patients achieved low disease activity (LDA)/remission: 45 patients in TNFi group (64.2%) and 18 (51.4%) in TCZ group. In TNFi group, patients who did not attain LDA/remission had a higher BMI (kg/m2) ([28.7±5.1] vs. [24.5±4.6], p=0.001) and baseline CDAI (26.3 [17.4-33.9] vs. 19.8 [14.0-28.8], p<0.03). However, no differences in BMI or baseline CDAI were observed between patients who achieved LDA after 6 months in TCZ group.
CONCLUSIONS:
Obesity influences the extent of LDA/remission in patients treated with TNFi, but not in patients treated with TCZ, probably because of underlying pathophysiological mechanisms intrinsic to the production of proinflammatory adi-pokines. Therefore, therapeutic strategies with a mechanism of action other than TNF inhibition would be more suitable for obese patients.
