Obesity reduces the drug survival of second line biological drugs following a first TNF-? inhibitor in rheumatoid arthritis patients - 13/05/15
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Abstract |
Objectives |
The aim of this study was to assess whether body mass index (BMI) affects clinical outcomes in rheumatoid arthritis (RA) patients starting a second line biological drug after failure of a first TNF-α blocker.
Methods |
From a longitudinal cohort, we analyzed 292 RA patients (66 obese, 109 overweight, and 117 normal-weight) treated with a first ever anti-TNF-α drug. Patients discontinuing the therapy were followed-up if began a second biological drug. Drug survival, by Kaplan-Meier life analysis, and 12 months disease remission based on the 28-joint Disease Activity Score (DAS28) were assessed for either course of biologics. The baseline predictors of clinical outcomes were assessed by Cox regression analysis.
Results |
Survival of the first anti-TNF-α drug was lower in obese (39.4%) than in normal-weight (49.1%) patients, but the difference was not statistically significant. Obese patients had the highest hazard to discontinue the first anti-TNF-α drug (HR 1.64, 1.02–2.62 95% IC, P=0.04), and the lowest percentage of DAS28-based disease remission at 12 months (P=0.04). In 97 (37 normal-weight, 36 overweight, 24 obese) patients who started a second non-anti-TNF-α biological drug, persistence on therapy was significantly lower in obese (43.5%) than in normal-weight (80%, P=0.04) group, and again obesity significantly predicted drug discontinuation (HR 2.9, 1.08–8.45 95% IC, P=0.04). Significantly, less obese patients attained a disease remission (12%, P=0.004) at 12 months.
Conclusion |
Our study provides evidence that obese RA patients poorly respond to second line non-anti-TNF-α drugs after failure of a first TNF-α inhibitor.
Le texte complet de cet article est disponible en PDF.Keywords : Body mass, Adalimumab, Etanercept, Infliximab, Rituximab
Plan
Vol 82 - N° 3
P. 187-191 - mai 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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