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Obesity and response to biological therapy in rheumatoid arthritis: the role of body mass index and adipose tissue cytokines


1, 2, 3, 4, 5, 6, 7, 8, 9, 10

 

  1. 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
  2. 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.
  3. Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IdiPAZ, Madrid, Spain.
  4. 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.
  5. Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IdiPAZ, Madrid, Spain.
  6. Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain.
  7. Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.
  8. 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.
  9. Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.
  10. Rheumatology Department, Hospital Universitario La Paz, Madrid and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research – IDIPAZ, Madrid, Spain.

CER15078
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PMID: 35084302 [PubMed]

Received: 17/08/2021
Accepted : 25/10/2021
In Press: 12/01/2022

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.

DOI: https://doi.org/10.55563/clinexprheumatol/a9gskx

Rheumatology Article