Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Abatacept is an effective biologic agent indicated for the treatment of RA.1 Recent studies have indicated that obesity and being overweight could reduce the effect of conventional DMARDs and of anti-TNF treatment in patients with RA. However, there are limited data on the effect of weight on the treatment response for abatacept.2,3 The aim of this study was to evaluate whether BMI is a modifier for the effect of abatacept measured by DAS28 (CRP) over the first 6 months of treatment in patients with RA.
Methods: Patients with RA from Radboud UMC and the Maartenskliniek were consecutively included if they were treated for ≥5 months with abatacept. Length and weight to calculate BMI had been assessed before treatment start. DAS28 (CRP) was prospectively assessed at baseline and 6 months. Concomitant treatment and treatment history were assessed at treatment start, and closest values for RF and anti-cyclic citrullinated peptide (anti-CCP) positivity obtained before baseline were used. BMI was classified as normal (BMI ≤25 kg/m2) or overweight (BMI >25 kg/m2). The relationship between BMI and response according to DAS28 (CRP) was analyzed using multivariate linear regression to control for confounding baseline covariates.
Results: A total of 113 patients were included in this analysis: 81% were female, mean (SD) age was 59 (13) years and median (P25–P75) disease duration was 13 (9–20) years. All patients had previously used other biologics, including anti-TNF. Conventional DMARDs were used as concomitant therapy in 58% of patients, most often MTX (32%); 69% of patients used IV abatacept. There were some baseline differences (p<0.10) between normal weight (39%) and overweight (61%) patients. Overweight patients were on average older (mean [SD] 60  vs 56  years), the proportion of males was higher (26 vs 7%), RF (75 vs 57%) and anti-CCP (77 vs 61%) positivity occurred more often, and SC abatacept was more frequently used (38 vs 21%), while they used more (median [P25–P75]) previous biologics (4 [3–4] vs 3 [2–4]). The mean (SD) baseline DAS28 (CRP) was 4.2 (1.0) in normal weight and 4.2 (1.2) in overweight patients (p=0.81). The mean (SD) change from baseline in DAS28 (CRP) over 6 months was –0.51 (1.4) in normal weight and –0.70 (1.8) in overweight patients (p=0.55). The difference of –0.19 in change of DAS28 (CRP) was reduced to –0.10 (p=0.71) after correcting for age, sex and baseline DAS28 (CRP), and further attenuated to –0.026 (p=0.92) if also corrected for anti-CCP positivity and number of previous biologic agents. Remission percentages (DAS28 <2.6) at 6 months were 23% in normal weight patients and 26% in overweight patients with an odds ratio (95% CI) of 1.2 (0.5, 2.9), which became 1.1 (0.4, 2.8) after correction for the same confounders.
Conclusion: In patients with RA, BMI was not a modifier of the effect of abatacept on DAS28 (CRP) at 6 months after treatment start. After controlling for confounders, the reduction in DAS28 (CRP) was the same for normal weight (BMI ≤25 kg/m2) and overweight (BMI >25 kg/m2) patients.
1. Cochrane Database Syst Rev 2009;7:CD007277.
2. Gremese E, et al. Arthritis Care Res 2013;65:94–100.
3. Sandberg M, et al. Ann Rheum Dis 2014;73:2029–33.
To cite this abstract in AMA style:Fransen J, Tweehuysen L, den Broeder A, Postema R, Alemao E, van den Hoogen F. The Effect of Body Mass on DAS28 Response in Patients with Rheumatoid Arthritis Treated with Abatacept [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-effect-of-body-mass-on-das28-response-in-patients-with-rheumatoid-arthritis-treated-with-abatacept/. Accessed September 19, 2019.
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