Florenzo Iannone1, Rosalinda Fanizzi2, Antonella Notarnicola3, Crescenzio Scioscia4, Maria Grazia Anelli5, Giovanni Lapadula6. 1. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: florenzo.iannone@uniba.it. 2. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: rosalinda.fanizzi@hotmail.it. 3. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: notarnicola.antonella@gmail.com. 4. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: crescenzio.scioscia@uniba.it. 5. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: marynelli@libero.it. 6. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, Medical School, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Electronic address: giovanni.lapadula@uniba.it.
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.
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 RApatients (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. Obesepatients 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 obesepatients attained a disease remission (12%, P=0.004) at 12 months. CONCLUSION: Our study provides evidence that obeseRApatients poorly respond to second line non-anti-TNF-α drugs after failure of a first TNF-α inhibitor.
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Authors: Florenzo Iannone; Delphine S Courvoisier; Jacques Eric Gottenberg; Maria Victoria Hernandez; Elisabeth Lie; Helena Canhão; Karel Pavelka; Merete Lund Hetland; Carl Turesson; Xavier Mariette; Denis Choquette; Axel Finckh Journal: Clin Rheumatol Date: 2016-12-14 Impact factor: 2.980
Authors: Siddharth Singh; Antonio Facciorusso; Abha G Singh; Niels Vande Casteele; Amir Zarrinpar; Larry J Prokop; Eduardo L Grunvald; Jeffrey R Curtis; William J Sandborn Journal: PLoS One Date: 2018-05-17 Impact factor: 3.240