ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 362

Response to Etanercept, but Not Infliximab or Adalimumab, Is Inversely Associated with Body Mass Index

James R. Maxwell1, Darren Plant2, Anne Barton2, Kimme L. Hyrich3, Ann W. Morgan4, John Isaacs5 and Anthony G. Wilson6, 1Infection & Immunity, University of Sheffield, Sheffield, United Kingdom, 2Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, United Kingdom, 3Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom, 4Section of Musculoskeletal Disease, NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom, 5Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom, 6Infection and Immunity, University of Sheffield, Sheffield, United Kingdom

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Drug Studies/Drug Safety/Drug Utilization/Disease Activity & Remission

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Recent studies have demonstrated inverse association between BMI and radiographic severity in patients with Rheumatoid Arthritis (RA). There is also preliminary evidence that body mass index (BMI) may influence response to anti-TNF treatment. We hypothesized that BMI may affect response to the three most commonly used anti-TNF agents.  The aim of this study was to determine if BMI is associated with response to individual anti-TNF agents in RA patients.

Methods:

2,160 patients were included, of whom 726 were treated with Infliximab, 737 Etanercept and 697 Adalimumab. Linear regression was used to investigate the influence of BMI, recorded at baseline on the change in DAS28 between baseline and 6 months of treatment, adjusted for gender, DMARD treatment, smoking, baseline DAS28 and HAQ score. Similar models were constructed to examine change in ESR and CRP.  The proportion of patients achieving EULAR improvement criteria according to stratified BMI was compared using the Chi squared test. Analyses were performed separately according to individual anti-TNF agents.

Results:

Mean disease duration was 13.7 years. BMI was not associated with change in DAS between baseline and 6 months and there was no statistical difference in the proportion of patients achieving EULAR response criteria according to BMI for any of the medications. For patients treated with Etanercept, but not Adalimumab or Infliximab, BMI was inversely associated with change in both ESR and CRP (p=0.003, and p<0.0001 respectively).

Conclusion:

Change in inflammatory activity in response to Etanercept, but not Infliximab or Adalimumab, is inversely associated with BMI.  Response to Infliximab has been reported to be reported to be inversely related to higher BMI in a study of 89 patients however our much larger study did not replicate this finding.  Our data suggest that higher doses of Etanercept may be required in RA patient with high BMI.  Studies are required to determine if lower doses of this agent could be used in patients with lower BMI.

Disclosure:

J. R. Maxwell,
None;

D. Plant,
None;

A. Barton,
None;

K. L. Hyrich,
None;

A. W. Morgan,
None;

J. Isaacs,
None;

A. G. Wilson,
None.

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