Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Certolizumab pegol (CZP) is an anti-TNF drug approved for rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), psoriasis (PSO) and Crohn’s disease (CD). Older age, comorbidities and corticosteroid (CS) use have been linked to increased risk of serious infectious events (SIEs) in CZP-treated patients (pts) with RA.1 However, the impact of overall disease burden on the risk of serious adverse events (SAEs) has not been fully examined for other CZP indications. High body mass index (BMI) has been linked to systemic inflammation and comorbidity risk.2,3 Greater disease burden in these pts may lead to increased CS use – a known risk factor for SAEs.1 This study aimed to examine the contribution of BMI and CS use to the risk of SIEs, malignancies and major adverse cardiovascular events (MACE) in CZP-treated pts across indications.
Methods: Safety data were pooled across 49 CZP clinical trials (27 RA, 1 axSpA, 1 PsA, 5 PSO, 15 CD). SAEs of potential concern were medically reviewed by an external expert committee using predefined case rules.4 Incidence rates (IR) were calculated per 100 pt‑years (PY). Multivariate Cox modeling was used to estimate relative risk (hazard ratio [HR]) of time to first SIE, malignancy or MACE by baseline BMI (< 18.5, 18.5–< 25, 25–< 30, ≥30 kg/m2) and CS use (yes, no). The model was adjusted for baseline age, sex, disease duration, methotrexate (MTX) use, prior anti-TNF drug use, and CZP indication.
Results: Across indications, 11,317 pts received CZP (21,695 PY total exposure; max: 7.8 years [yrs]; exposure for RA: 13,542 PY; axSpA: 978 PY; PsA: 1,316 PY; PSO: 1,481 PY; CD: 4,378 PY). Mean BMI was 27.8 kg/m2 in RA, 27.6 kg/m2 in axSpA, 29.8 kg/m2 in PsA, 30.1 kg/m2 in PSO, and 24.0 kg/m2 in CD. Overall, 4,132 pts (37%) used CS at baseline, more so in RA (46%) and axSpA (51%). Across indications, IRs were 0.82/100 PY for all malignancies (0.66/100 PY excluding non-melanoma skin cancer [NMSC]), 0.47/100 PY for MACE, and 3.62/100 PY for SIEs. According to the Cox model, age ≥45 yrs, disease duration < 1 yr (compared with ≥5 yrs), and no MTX use were risk factors for malignancies (including NMSCs); BMI and CS use did not have a detectable impact (Table). MACE risk was higher in RA and PsA; BMI ≥30 kg/m2 was a risk factor for MACE, in addition to age ≥45 yrs and male sex (Table). Compared with RA, SIE risk was higher in CD and lower in PSO and PsA; key risk factors included age ≥65 yrs, disease duration ≥10 yrs and CS use. Without CS use, BMI did not impact SIE risk, but among CS users, SIE risk was higher for obese pts (Table)
Conclusion: In CZP-treated pts across indications, malignancy risk was not influenced by BMI or CS use. As expected, obesity and CS use increased the risk of MACE. The SIE risk associated with CS use was compounded in obese pts, which may reflect the contribution of comorbidities, disease activity or other factors not examined here.
1. Curtis JR. Arthritis Res Ther 2017;19:276; 2. Pérez de Heredia F. Proc Nutr Soc 2012;71:332–8; 3. Harpsøe MC. Int J Epidemiol 2014;43:843–55; 4. Curtis JR. RMD Open 2019;.
To cite this abstract in AMA style:Bykerk V, Blauvelt A, Curtis J, Gaujoux-Viala C, Kvien T, Sandborn W, Winthrop K, Popova C, Mariette X. Body Mass Index and Systemic Corticosteroid Use as Indicators of Disease Burden and Their Influence on the Safety Profile of Certolizumab Pegol Across Indications [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/body-mass-index-and-systemic-corticosteroid-use-as-indicators-of-disease-burden-and-their-influence-on-the-safety-profile-of-certolizumab-pegol-across-indications/. Accessed November 18, 2019.
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