Metabolic Syndrome, Adipokines, and Response to Advanced Therapies in Rheumatoid Arthritis

Joshua F Baker; George Reed; Ted R Mikuls; Geoffrey M Thiele; Dimitrios A Pappas; Christina Charles-Schoeman; Monica Guma; Leslie R Harrold; Jeffrey R Curtis; Joel M Kremer

doi:10.1002/art.43034

Metabolic Syndrome, Adipokines, and Response to Advanced Therapies in Rheumatoid Arthritis

Arthritis Rheumatol. 2024 Oct 17. doi: 10.1002/art.43034. Online ahead of print.

Authors

Affiliations

¹ Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center and the University of Pennsylvania, Philadelphia.
² University of Massachusetts Chan Medical School, Worcester.
³ Department of Veterans Affairs Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center, Omaha.
⁴ Corrona Research Foundation, Albany, and Columbia University, New York City, New York.
⁵ University of California, Los Angeles.
⁶ University of California San Diego.
⁷ University of Massachusetts Chan Medical School, Worcester, and Corrona Research Foundation, Albany, New York.
⁸ University of Alabama at Birmingham.
⁹ Corrona Research Foundation and Albany Medical College, Emeritus, New York.

PMID: 39420627
DOI: 10.1002/art.43034

Abstract

Objective: We determined if metabolic syndrome, its components, and adipokines (adiponectin, leptin, and fibroblast growth factor-21) were associated with response to advanced therapies among patients with rheumatoid arthritis (RA).

Methods: This study included participants with RA initiating either tumor necrosis factor inhibitor (TNFi) or non-TNFi biologic therapies from the Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) cohort within the CorEvitas registry. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III definition. Adipokines were assessed on stored samples from a subsample of responders and nonresponders (n = 200). The primary outcome was the achievement of a change as large as the minimal clinically important difference (MCID) for the Clinical Disease Activity Index (CDAI) at 6 months.

Results: Among 2,368 participants, 687 (29%) had metabolic syndrome. Metabolic syndrome was associated with lower odds of achieving CDAI MCID (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.56-0.86, P = 0.001) with a dose-dependent decrease in response rate according to the number of components present. Model fit was superior for metabolic syndrome compared with body mass index. Associations between metabolic syndrome and MCID achievement were similar between patients receiving TNFi (OR 0.65, 95% CI 0.49-0.87, P = 0.003) versus non-TNF therapies (OR 0.76, 95% CI 0.55-1.04, P = 0.08 [P for interaction = 0.49]). Adipokines were not associated with MCID achievement.

Conclusion: Metabolic syndrome is associated with lower response rates with the initiation of an advanced therapy in RA, with similar effects for both TNFi and non-TNFi agents. Adipokines were strongly associated with metabolic syndrome but were not associated with clinical response.

© 2024 Corrona Research Foundation. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Abstract

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