Obesity and reduction of the response rate to anti–tumor necrosis factor α in rheumatoid arthritis: An approach to a personalized medicine

Gremese, Elisa; Carletto, Antonio; Padovan, Melissa; Atzeni, Fabiola; Raffeiner, Bernd; Giardina, Anna; Favalli, Ennio Giulio; Erre, Gian Luca; Gorla, Roberto; Gargiulo, Mauro; Foti, Rosario; Cantini, Fabrizio; Salvarani, Carlo; Olivieri, Ignazio; Lapadula, Giovanni; Ferraccioli, Gianfranco

doi:10.1002/acr.21768

Cited by 180 publications

(155 citation statements)

References 26 publications

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“…This finding should be interpreted cautiously because of the small number of patients who weighed ≥ 100 kg; it is consistent with observations from Week 24 6 . A similar trend was reported in TCZ-IV studies 5 , and in other studies, obese patients had lower responses to anti-TNF agents 13 .…”

Section: Rheumatologysupporting

confidence: 87%

Two-year Efficacy and Safety of Subcutaneous Tocilizumab in Combination with Disease-modifying Antirheumatic Drugs Including Escalation to Weekly Dosing in Rheumatoid Arthritis

Kivitz

Olech²,

Borofsky³

et al. 2017

J Rheumatol

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Objective.To evaluate the longterm efficacy and safety of subcutaneous tocilizumab (TCZ-SC) every 2 weeks (q2w) over 2 years in patients with rheumatoid arthritis who have an inadequate response to disease-modifying antirheumatic drugs (DMARD).Methods.Patients (n = 656) were randomized 2:1 to TCZ-SC 162 mg q2w or placebo-SC q2w plus DMARD. After a 24-week double-blind period, patients (n = 457) were rerandomized to open-label TCZ-SC q2w by means of prefilled syringe or autoinjector. Escape therapy with weekly TCZ-SC was available for patients with inadequate efficacy from Week 12. Maintenance of response and safety to 2 years was assessed. Analyses used nonresponder imputation.Results.The American College of Rheumatology (ACR) 20 response after TCZ-SC was maintained beyond Week 24 and was > 70% at each timepoint. ACR50/70, 28-joint Disease Activity Score remission, and ≥ 0.30 decrease from baseline in the Health Assessment Questionnaire–Disability Index response rates were also maintained after Week 24 in the TCZ-SC arm (≥ 50%, > 25%,> 32% and > 56%, respectively). Following escape for inadequate efficacy, many patients achieved ACR20 at the end of the study, 35% after escape from TCZ-SC, and 63% from placebo. The rates of serious adverse events [(11.20/100 patient-years (PY)] including serious infections (3.25/100 PY) were stable through Week 96. No association between anti-TCZ antibody development and loss of efficacy or adverse events was observed.Conclusion.Efficacy and safety of TCZ-SC q2w was maintained up to 2 years and remained comparable with previously published data for intravenous TCZ. Dose escalation to weekly TCZ-SC was associated with ACR responses in prior nonresponders and was well tolerated.

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Section: Rheumatologysupporting

confidence: 87%

Two-year Efficacy and Safety of Subcutaneous Tocilizumab in Combination with Disease-modifying Antirheumatic Drugs Including Escalation to Weekly Dosing in Rheumatoid Arthritis

Kivitz

Olech²,

Borofsky³

et al. 2017

J Rheumatol

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“…Since a high BMI is associated with poor outcomes in patients with RA and causes negative effects on the treatment, care should be taken to maintain weight control. 33,34 Extra-articular involvement also plays an important role in the follow-up and treatment of patients with RA. The most common comorbid diseases in the current study were hypertension and peptic ulcers.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients With Rheumatoid Arthritis in Turkey: Results From the Turkish League Against Rheumatism Rheumatoid Arthritis Registry

et al. 2015

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Objectives: This study investigates the demographic and clinical characteristics of patients with rheumatoid arthritis (RA) in Turkey, and attempts to identify strategies for the prevention, treatment, and support of RA. Patients and methods: A total of 2,359 patients (1,966 females, 393 males; mean age 51.6±12.5 years; range 18 to 75 years) with RA from 36 centers across Turkey, who were recorded in the Turkish League Against Rheumatism (TLAR) RA Registry between September 2007 and March 2011, were evaluated. Patients' demographic and clinical data were recorded. Disease activity, functional status, and radiographic damage were measured using the Disease Activity Score 28, the Health Assessment Questionnaire, and van der Heijde modified Sharp scoring method. Results: The mean duration of academic education received was 5.2±3.8 years, and 74.6% of the patients were homemakers. Non-biological diseasemodifying anti-rheumatic drugs were used by 91.0% of the patients, while 10.2% used biological disease-modifying anti-rheumatic drugs. The mean Disease Activity Score 28, Health Assessment Questionnaire, and Sharp scores were 4.0±1.4, 0.38±0.37, and 31.2±57.1, respectively. Of the patients, 17.8% were in remission and 14.1% had low disease activity rates, while 42.7% and 25.5% had moderate and high disease activity rates. Conclusion:The majority of patients with RA in Turkey are middle-aged homemakers. Despite the high rates of disease-modifying anti-rheumatic drugs use, the majority of patients had moderate and high disease activity. These findings indicate that treatment needs of RA patients are not met sufficiently.

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“…In our study AS patients'-both men and women-mean BMI and body fat mass (%) were higher than the WHO health criteria. It has been found that obesity represents a risk factor for a poor remission rate in RA patients treated with anti TNF-α agents [25]. And also optimizing the nutritional status influences the therapeutic effect of anti TNF-α [26].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Anti TNF-Alpha Therapy in Nutritional Status and Serum Leptin Levels in Patients with Ankylosing Spondylitis

Zehra¹,

Makbule²,

Mesut³

2017

IJCN

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The objective of this study was to investigate the effect of anti TNF-α therapy on nutritional status and serum leptin levels in patients with ankylosing spondylitis. This study was conducted on two groups of AS patients. First group included 48 patients receiving anti TNF-α treatment together with NSAID. Second group included 48 patients receiving only NSAID treatment. Descriptive information, food consumption and physical activity about patients collected with a survey. Anthropometric measurements were measured with body analysis scale and serum leptin was also assessed. As results, there was significant difference in daily energy consumption between both men and women with and without anti TNF-α treatment (2399 kcal and 2069 kcal p=0,036, 2102 kcal and 1659 kcal p=0,001). There was no significant difference of serum leptin levels between patients receiving anti TNF-α and only NSAID treatment (p>0,05). However, the women's leptin levels (12,4±8,2 ng/mL) were significantly higher compared to men (3,7±3,02 ng/mL). There was positive correlation of serum leptin levels, BMI and body fat mass between men and women with and without anti TNF-α treatment. The anthropometric measurements between both men and women groups were not significant (p>0,05). No statistical difference was found between the physical activity assessments of the groups (p>0,05). In conclusion, there was no significant effect of anti-TNF-α treatment in AS patients on serum leptin levels, physical activity, and anthropometric measurements. However, anti TNF-α therapy receiving patients' daily energy and nutrient consumption were higher. This study showed anti TNF-α therapy has been effective on food consumption of patients with ankylosing spondylitis.

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Obesity and reduction of the response rate to anti–tumor necrosis factor α in rheumatoid arthritis: An approach to a personalized medicine

Cited by 180 publications

References 26 publications

Two-year Efficacy and Safety of Subcutaneous Tocilizumab in Combination with Disease-modifying Antirheumatic Drugs Including Escalation to Weekly Dosing in Rheumatoid Arthritis

Two-year Efficacy and Safety of Subcutaneous Tocilizumab in Combination with Disease-modifying Antirheumatic Drugs Including Escalation to Weekly Dosing in Rheumatoid Arthritis

Characteristics of Patients With Rheumatoid Arthritis in Turkey: Results From the Turkish League Against Rheumatism Rheumatoid Arthritis Registry

The Effect of Anti TNF-Alpha Therapy in Nutritional Status and Serum Leptin Levels in Patients with Ankylosing Spondylitis

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