The Influence of Obesity on Response to Tumour Necrosis factor-α Inhibitors in Psoriatic Arthritis: Results From the DANBIO and ICEBIO Registries

Rheumatology (Oxford). 2016 Dec;55(12):2191-2199. doi: 10.1093/rheumatology/kew326. Epub 2016 Sep 19.

Abstract

Objectives: To investigate the impact of obesity on response to the first TNF-α inhibitor (TNFI) treatment course in patients with PsA followed in routine care.

Methods: We performed an observational cohort study based on the Danish and Icelandic biologics registries. Kaplan-Meier plots, Cox and logistic regression analyses were performed to study the impact of obesity (BMI ⩾30 kg/m2) on TNFI adherence and response after 6 months (according to 20/50/70% improvement in ACR criteria and EULAR criteria). Subanalyses studied the impact of obesity according to gender, TNFI type and nationality.

Results: Among 1943 PsA patients (193 Icelandic/1750 Danish) identified in the registries, 1271 (65%) had available BMI and 408 (32%) were obese. The median follow-up-time was 1.5 years [interquartile range (IQR) 0.5-3.9]. Obese patients had higher baseline disease activity, for example, 28-joint DAS [mean 4.6 (sd 1.2) vs 4.4 (1.2)]; CRP [median 9 mg/l (IQR 5-19) vs 7 (3-18)] and visual analogue scale-pain [66 mm (IQR 48-76) vs 60 (38-74)], compared with non-obese patients (all P < 0.05). TNFI adherence was shorter in obese patients, especially among men, where the median TNFI duration was 2.5 years (95% CI 1.7, 3.2) in obese vs 5.9 (4.1, 7.7) in non-obese patients (P < 0.01). A EULAR good or moderate (EGOM) response was achieved by 55% of obese vs 65% of non-obese patients after 6 months (P = 0.02). In multivariable analyses, obesity increased the risk of TNFI withdrawal [hazard ratio 1.6 (95% CI 1.3, 2.0)] and reduced odds for EGOM response [odds ratio 0.47 (95% CI 0.29, 0.72)]. The impact of obesity was significant across genders, TNFI types and nationality.

Conclusion: Obesity was associated with higher disease activity and seemed to diminish response and adherence to TNFIs in PsA.

Keywords: anti-TNF drugs; obesity; outcome measures; psoriatic arthritis; registry.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adalimumab / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Psoriatic / drug therapy*
  • Biological Products / therapeutic use*
  • Certolizumab Pegol / therapeutic use
  • Denmark
  • Etanercept / therapeutic use
  • Female
  • Humans
  • Iceland
  • Infliximab / therapeutic use
  • Kaplan-Meier Estimate
  • Male
  • Medication Adherence
  • Middle Aged
  • Obesity / complications*
  • Prospective Studies
  • Registries
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Biological Products
  • Tumor Necrosis Factor-alpha
  • golimumab
  • Infliximab
  • Adalimumab
  • Etanercept
  • Certolizumab Pegol