Obesity reduces the response rate to anti TNFα in rheumatoid arthritis. an approach to a personalized medicine
Arthritis Care & Research , 06/26/2012
Gremese E et al. – Obesity represents a risk factor for a poor remission rate in long standing rheumatoid arthritis (RA) treated with anti–TNFα. A personalized treatment might be a possible solution.Methods
- Patients were identified from fifteen outpatient clinics of university–hospitals and hospitals in Italy, taking part in the GISEA (Gruppo ItalianoStudio Early Arthritis) network.
- Disease activity score (DAS28 joints), body mass index (BMI: categorized as a BMI <25, BMI 25–30 and BMI >30), acute phase reactants, rheumatoid factor IgM, anti–cyclic citrullinated peptide, values were collected.
- DAS28 remission was defined as a score <2.6 lasting for at least 3 months.
- 641 outpatients with long standing RA, receiving anti–TNFα blockers (Adalimumab, n=260; Etanercept, n=227; Infliximab, n=154), recruited from 2006 to 2009 and monitored for at least 12 months, were analyzed.
- The DAS28 at the baseline was 5.6±1.4.
- A BMI value >30 was recorded in 66 out of 641 RA patients (10.3%).
- After 12 months of anti–TNFα treatment, a DAS28<2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI 25–30 and in 32.9% of the patients with a BMI<25 (p=0.01).
- The lowest percentage of remission, statistically significant versus adalimumab and etanercept (p=0.003), was observed with infliximab.