Adding conventional DMARDs to TNF inhibitors may be beneficial for obese axSpA patients
medwireNews: Using conventional synthetic (cs)DMARDs in addition to tumor necrosis factor (TNF) inhibitor therapy may result in an increased likelihood of clinical response among overweight and obese patients with axial spondyloarthritis (axSpA), researchers report.
The study included a total of 180 patients treated with standard doses of either infliximab (n=74) or adalimumab (n=106) between 2000 and 2015, 57% of whom were categorized as overweight or obese (BMI>25 kg/m2). In all, 44% of patients additionally received csDMARD treatment, consisting of sulfasalazine (20%), methotrexate (14%), and a combination of both (10%).
Borja Hernández-Breijo (University Hospital La Paz, Madrid, Spain) and co-workers report that among patients who were overweight or obese, those who received csDMARDs plus a TNF inhibitor were a significant 7.86 times more likely to achieve a clinical response, defined as a decrease in BASDAI score of at least 2.0 points and a decrease in ASDAS of at least 1.1 points, than those given a TNF inhibitor only.
Similarly, overweight or obese patients receiving combination therapy had a significant 4.84-fold higher likelihood of achieving clinical remission (BASDAI <2, C-reactive protein ≤5 mg/L, and ASDAS <1.3) than those on TNF inhibitor monotherapy.
No association between concomitant csDMARD treatment and rates of clinical response or remission were observed among patients with normal bodyweight, however.
The researchers also demonstrated that patients with normal bodyweight had significantly greater serum persistence of TNF inhibitors than those who were overweight or obese, with an odds ratio (OR) of 18.38 on multivariable logistic regression analysis. Concomitant csDMARD use was significantly associated with TNF inhibitor persistence in the multivariable analysis (OR=3.82), as was disease duration (OR=0.93).
These findings are “in agreement with previous data [suggesting] that BMI is associated with lower TNF [inhibitor] serum drug persistence,” providing further evidence to suggest that “obese patients should be encouraged to achieving normal weight,” say Hernández-Breijo and team.
“Nevertheless, based on the results of this study, if losing weight is proven impossible, it can be hypothesised that the co-medication with csDMARDs […] could be of additional value to increase treatment success in overweight/obese patients,” they add.
And the team concludes in Arthritis Research & Therapy that “the use of concomitant csDMARDs with TNF [inhibitors] would not be justified in axSpA patients with normal weight as it would not increase the probability of achieving clinical response.”
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