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Some studies have showed that obesity, as determined by a body mass index (BMI) ≥30 kg/m2, hampers treatment response to tumour necrosis factor-alpha blockers (TNFb) in patients with axial spondyloarthritis (axSpA).1 However, no study has specifically determined the impact of abdominal adiposity as assessed by waist circumference (WC), on treatment response to TNFb in early axSpA. As compared with BMI, WC is more strongly associated with the metabolic disturbances thought to underlie many of the obesity‐related conditions. Notably, it is associated with low-grade inflammation and all-cause and cardiovascular mortality with or without adjustment for BMI.2 Therefore, we hypothesise that WC could be also an independent factor for TNF b response.
We conducted an analysis to assess the impact of abdominal adiposity on the treatment effect of TNFb in real life in an early axSpA population. Devenir des Spondylarthropathies Indifférenciées Récentes cohort3 is a multicenter, observational, prospective cohort of 708 patients with early (<3 years) inflammatory back pain suggestive of axSpA. Demographics (weight, height, BMI and WC) and disease characteristics (including treatment) were collected every 6 months. Patients receiving a TNFb for the first 2 years of following were matched to their nearest neighbour (according to their propensity score value) to patients receiving any other treatment (usual care, …
Handling editor Josef S Smolen
Contributors AM designed the study, performed the statistical analysis and drafted the letter. PR designed the study and critically reviewed the results and the letter. ST, BC and MD critically reviewed the letter.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.