Body Mass Index and Response to Infliximab in Rheumatoid Arthritis

Clin Exp Rheumatol. Jul-Aug 2015;33(4):478-83. Epub 2015 May 11.

Abstract

Objectives: Excess adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetics consequences. Previous studies have suggested that obesity could negatively affect the response to anti-TNF-α agents, notably infliximab (IFX). We aimed to determine whether body mass index (BMI) is involved in the response to IFX in rheumatoid arthritis (RA).

Methods: We retrospectively examined data for 76 RA patients receiving IFX. BMI was calculated before treatment, and change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, tender and swollen joint count was analysed at 6 months after treatment. The primary outcome was decrease in DAS28 ≥1.2. Secondary outcomes were good response and remission according to EULAR.

Results: At baseline, the median [interquartile range] BMI was 26.6 [22.6-30.6] kg/m2. The number of patients with normal weight, overweight and obesity was 25, 29 and 22. In multivariable analyses, IFX treated patients with lower BMI showed a more frequent DAS28 decrease ≥1.2 (25.5 [22.3-28.3] vs. 28.0 [23.2-32.5], p=0.02, odds ratio [OR] 0.88 [95% confidence interval 0.79-0.98]), EULAR good response (25.3 [21.9-27.5] vs. 27.5 [24.3-31.2], p=0.03, OR 0.87 [0.76-0.99]) and EULAR remission, although not significant (25.3 [21.9-26.4] vs. 27.5 [23.2-30.9], p=0.14, OR 0.88 [0.75-1.04]).

Conclusions: Obesity may negatively influence the response to IFX in RA. These data could help physicians to choose biologic agents for obese RA patients.

MeSH terms

  • Adult
  • Antibodies, Monoclonal / administration & dosage*
  • Antirheumatic Agents / administration & dosage
  • Arthralgia / diagnosis*
  • Arthralgia / physiopathology
  • Arthritis, Rheumatoid* / blood
  • Arthritis, Rheumatoid* / diagnosis
  • Arthritis, Rheumatoid* / drug therapy
  • Arthritis, Rheumatoid* / epidemiology
  • Arthritis, Rheumatoid* / physiopathology
  • Blood Sedimentation
  • Body Mass Index
  • C-Reactive Protein / analysis
  • Comorbidity
  • Drug Monitoring / methods
  • Female
  • France / epidemiology
  • Humans
  • Infliximab
  • Male
  • Middle Aged
  • Obesity / diagnosis
  • Obesity / epidemiology*
  • Pain Measurement
  • Patient Acuity
  • Remission Induction / methods
  • Retrospective Studies
  • Risk Factors
  • Tumor Necrosis Factor-alpha / blood

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein
  • Infliximab