Association between concomitant csDMARDs and clinical response to TNF inhibitors in overweight patients with axial spondyloarthritis

Arthritis Res Ther. 2019 Feb 20;21(1):66. doi: 10.1186/s13075-019-1849-3.


Background: The aim of our study was to investigate the influence of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and body mass index (BMI) on circulating drug levels and clinical response to tumour necrosis factor inhibitor (TNFi) therapy in axial spondyloarthritis (axSpA) patients.

Methods: Prospective observational study during 1 year with 2 cohorts (Madrid and Amsterdam) including 180 axSpA patients treated with standard doses of infliximab or adalimumab. Patients were stratified by BMI, being 78 (43%) normal weight (18.5-24.9 kg/m2) and 102 (57%) overweight/obese (≥ 25.0 kg/m2). After the first year of treatment, TNFi trough levels were measured by capture ELISA. Clinical response to TNFi was defined as ∆BASDAI ≥ 2 and clinical remission as BASDAI < 2 and CRP ≤ 5 mg/L. Logistic regression models were employed to analyse the association between concomitant csDMARDs and BMI with drug levels and clinical response.

Results: Seventy-nine patients (44%) received concomitant csDMARDs. The administration of concomitant csDMARDs (OR 3.82; 95% CI 1.06-13.84) and being normal weight (OR 18.38; 95% CI 2.24-150.63) were independently associated with serum TNFi drug persistence. Additionally, the use of concomitant csDMARDs contributed positively to achieve clinical response (OR 7.86; 95% CI 2.39-25.78) and remission (OR 4.84; 95% CI 1.09-21.36) in overweight/obese patients, but no association was found for normal-weight patients (OR 1.10; 0.33-3.58).

Conclusions: The use of concomitant csDMARDs with TNFi may increase the probability of achieving clinical response in overweight/obese axSpA patients. Further research studies including larger cohorts of patients need to be done to confirm it.

Keywords: Axial spondyloarthritis; Body mass index; Clinical response; Concomitant csDMARDs; TNF inhibitors.

Publication types

  • Observational Study

MeSH terms

  • Adalimumab / therapeutic use
  • Adult
  • Antirheumatic Agents / chemical synthesis
  • Antirheumatic Agents / therapeutic use*
  • Body Mass Index
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infliximab / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Overweight / complications
  • Overweight / drug therapy*
  • Prospective Studies
  • Remission Induction
  • Spondylarthritis / complications
  • Spondylarthritis / drug therapy*
  • Tumor Necrosis Factor Inhibitors / therapeutic use*


  • Antirheumatic Agents
  • Tumor Necrosis Factor Inhibitors
  • Infliximab
  • Adalimumab