Abstract
The aim of this study was to investigate the association between body-mass index (BMI) and remission in RA patients receiving conventional synthetic (cs-) or the biological Disease-Modifying Antirheumatic Drug (DMARD), tocilizumab. Individual participant data (IPD) were pooled from five trials investigating tocilizumab and/or csDMARDs therapy (primarily methotrexate) for RA. Time to first remission was recorded according to the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). BMI was classified according to WHO definitions. Associations between baseline BMI and remission were assessed by Cox-proportional hazard analysis. IPD were available from 5428 patients treated with tocilizumab ± csDMARDs (n = 4098) or csDMARDs alone (n = 1330). Of these, 1839 (33.9%) had normal BMI, 1780 (32.8%) overweight, 1652 (30.4%) obese and 157 (2.9%) were underweight. Obesity, compared to normal BMI, was associated with less frequent remission using SDAI (adjusted HR 0.80 [95% CI 0.70–0.92]) and CDAI (adjusted HR 0.77 [0.68–0.87]). As continuous variable, increased BMI was associated with less frequent SDAI (P = 0.001) and CDAI (P = 0.001) defined remission. No heterogeneity in identified associations was observed between studies (P = 0.08) or treatments (P = 0.22). Obesity was negatively associated with RA disease remission regardless of RA therapy, suggesting that baseline BMI should be considered as a stratification factor in future RA trials.
Highlights
The aim of this study was to investigate the association between body-mass index (BMI) and remission in Rheumatoid arthritis (RA) patients receiving conventional synthetic or the biological Disease-Modifying Antirheumatic Drug (DMARD), tocilizumab
No significant heterogeneity in BMI distribution was observed between trials (P = 0.226)
In contrast to Levitsky et al and Schafer et al s tudies[9,21], the analysis presented included Individual participant data (IPD) pooled from 5 randomised control trials (RCTs) and 5502 patients, of whom 4212 patients received treatment containing TCZ, and RA remission was defined using American College of Rheumatology (ACR)/EULAR criteria[19] which are more stringent in defining remission than the DAS28 used in the Levitsky et al and Schafer et al s tudies[22]
Summary
The aim of this study was to investigate the association between body-mass index (BMI) and remission in RA patients receiving conventional synthetic (cs-) or the biological Disease-Modifying Antirheumatic Drug (DMARD), tocilizumab. Abbreviations ACR American College of Rheumatology bDMARDs Biological disease-modifying anti-rheumatic drugs BMI Body mass index CDAI Clinical disease activity index CRP C-reactive protein csDMARDs Conventional-synthetic disease-modifying anti-rheumatic drugs DAS28-ESR Disease Activity Score using the erythrocyte sedimentation rate DMARDs Disease-modifying anti-rheumatic drugs ESR Erythrocyte sedimentation rate HR Hazard ratio IPD Individual-participant data IV Intravenous MTX Methotrexate RA Rheumatoid arthritis RCT Randomised control trials. Conventional synthetic disease modifying anti-rheumatic drugs [csDMARDs—e.g. methotrexate (MTX), hydroxychloroquine, leflunomide and sulfasalazine] and biological DMARDs [bDMARDs—e.g. the interleukin-6 receptor blocker, tocilizumab (TCZ)] are the current backbone of treatment that aims to control inflammation and prevent irreversible outcomes of uncontrolled R A1. Obesity, characterised by excess accumulation of adipose tissue, is associated with elevated levels of proinflammatory adipokines[3]
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