Background Few studies have investigated the impact of obesity on response to tumour necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA).
Objectives To investigate the impact of different Body Mass Index (BMI) categories on TNFi response in a large cohort of patients with axSpA.
Methods Patients within the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS criteria for axSpA, started a first TNFi after recruitement and had available BMI data as well as a baseline and follow-up visit at 1 year (±6mo) (N=632). Patients were categorized according to BMI: normal (BMI 18.5 to <25), overweight (BMI 25 to 30) and obese (BMI >30). We evaluated the proportion of patients achieving the 40% improvement ASAS criteria (ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued the TNFi were considered non-responders. We controlled for age, sex, HLA-B27, axSpA-type, BASDAI, BASMI, elevated CRP, current smoking and physical exercise in multiple adjusted logistic regression analyses.
Results In comparison to normal weight and overweight patients, obese individuals were significantly older, had a longer symptom duration and higher BASFI and BASMI levels, while ASDAS levels were comparable between the 3 groups (Table 1). Data to calculate the ASAS40 response was available in 496 patients (78%). It was reached by 44%, 35% and 28% of patients with normal weight, overweight and obesity, respectively, (p=0.02; Table 2). A significantly lower odds ratio (OR) for achieving ASAS40 response was found in adjusted analyses in obese patients vs patients with normal BMI (OR 0.30, 95% confidence interval (CI) 0.11–0.73, p=0.01). Comparable results were found for the other outcomes assessed. The respective adjusted ASAS40 OR in overweight vs. normal weight patients was 0.69, 95% CI 0.38–1.24, p=0.22.
Conclusions Obesity is associated with significantly lower response rates to TNFi in patients with axSpA.
Disclosure of Interest None declared