Longitudinal associations between body mass index and changes in disease activity and radiographic progression in rheumatoid arthritis patients treated with infliximab

Journal article

Objectives: Treatment response is worse in obese patients with rheumatoid arthritis (RA), including patients on weight-adjusted therapies like infliximab. We aimed to assess the association between body mass index (BMI) and changes in RA disease activity and radiographic progression over time. Methods: We included infliximab users with an RA diagnosis in the Swiss Clinical Quality Management in Rheumatic Diseases registry (1997–2020). Two cohorts were defined: (1) starting from their first BMI measurement or disease activity score (DAS28-esr), and (2) from their first BMI measurement or radiographic assessment (Rau score). We evaluated the coefficient and 95% CI of BMI with changes in mean DAS28-esr (cohort 1) and mean Rau scores (a structural joint damage score, cohort 2) using generalised estimation equations, overall and stratified by BMI categories. Results: Cohort 1 comprised 412 patients (74% women, mean age 53 years, mean BMI 25). We observed no change in mean DAS28-esr with increasing BMI overall (adjusted coefficient: 0.00, 95% CI −0.02 to 0.02), or in BMI categories. Cohort 2 comprised 187 patients highly alike to those in cohort 1. We observed a significant decrease of 1.05 in mean Rau scores for every increase in BMI unit (adjusted coefficient: −1.05, 95% CI −1.92 to −0.19). Results remained statistically non-significant across BMI categories. Conclusions: Our longitudinal investigation suggests that BMI increase may not lead to changes in DAS28-esr in patients receiving infliximab, despite the weight-adapted dose. Yet, there may be a decrease in erosions with increasing weight non-limited to obese patients.ISSN:2056-593

Authors: Burkard, T; Vallejo-Yagüe, E; Lauper, K; Finckh, A; Hügle, T

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: RMD Open: Rheumatic and Musculoskeletal Diseases
• Volume: 9
• Issue: 4
• Pages: e003396-e003396
• Publication date: 2023-10-01
• DOI: 10.1136/rmdopen-2023-003396
• EISSN: 2056-5933
• ISSN: 2056-5933
• Language: English
• Keywords: Internal medicine; Infliximab; Medicine; Body mass index; Disease; Cohort study; Cohort; Rheumatoid arthritis