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Scientific Abstracts
Poster Tours
Early RA and comorbidities
POS0324 OBESITY IS A RISK FACTOR FOR POOR RESPONSE TO TREATMENT IN EARLY RHEUMATOID ARTHRITIS - A NORD-STAR SPIN-OFF STUDY
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  1. V. Dubovyk1,
  2. G. Gröndal2,3,
  3. B. Gudbjornsson2,3,
  4. E. A. Haavardsholm4,
  5. M. Heiberg4,
  6. M. L. Hetland5,6,
  7. K. Hørslev-Petersen7,8,
  8. M. C. Kapetanovic9,
  9. A. Kastbom10,
  10. J. Lampa11,
  11. K. Lend11,12,
  12. D. Nordström13,
  13. M. Nurmohamed12,14,
  14. M. Rizk15,
  15. A. Söderbergh16,
  16. T. Uhlig4,17,
  17. M. Østergaard5,6,
  18. R. Van Vollenhoven11,12,
  19. A. Rudin1,
  20. C. Maglio1
  1. 1University of Gothenburg, Rheumatology and Inflammation research, Gothenburg, Sweden
  2. 2Landspitali University Hospital, Centre for Rheumatology Research, Reykjavik, Iceland
  3. 3University of Iceland, Faculty of Medicine, Reykjavik, Iceland
  4. 4Diakonhjemmet Hospital, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Oslo, Norway
  5. 5University of Copenhagen, Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen, Denmark
  6. 6Rigshospitalet, Copenhagen Center for Arthritis Research (COPECARE) and DANBIO Center for Rheumatology and Spine Diseases, Glostrup, Denmark
  7. 7University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
  8. 8University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
  9. 9Skåne University Hospital, Departament of Clinical Sciences, Lund, Sweden
  10. 10Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden
  11. 11Karolinska Institute, Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Stockholm, Sweden
  12. 12Amsterdam University Medical Centers, Department of Rheumatology and Amsterdam Rheumatology Center, Amsterdam, Netherlands
  13. 13Helsinki University Hospital, Department of Rheumatology, Helsinki, Finland
  14. 14Amsterdam Rheumatology & immunology center location Reade, Rheumatology, Amsterdam, Netherlands
  15. 15Värmlands Hospital, Rheumatology Clinic, Västerås, Sweden
  16. 16Örebro University Hospital, Departament of Rheumatology, Örebro, Sweden
  17. 17University of Oslo, Faculty of Medicine, Oslo, Norway

Abstract

Background Several therapeutic options are currently available to treat rheumatoid arthritis (RA); however, the response to treatment is highly variable, and not all patients achieve clinical remission [1]. Obesity is suggested to lower the chances of remission [2], even though a recent observational study has shown that obesity is not associated with reduced response to conventional synthetic anti-rheumatic drugs in patients with early RA [3].

Objectives The aim of this study is to determine if obesity affects the response to treatment in participants with early RA.

Methods This report includes 393 Swedish patients from the NORD-STAR study, which is a multicenter, randomized trial on 812 patients with untreated early RA [4]. The 393 participants have been randomized at baseline into 4 arms of treatment: methotrexate combined with (1) prednisolone, (2) certolizumab, (3) abatacept, or (4) tocilizumab. Scores for disease activity and blood samples were measured and collected before randomization and at 24-week follow-up.

Multiple linear regression and binary logistic regression analyses were performed after adjustment for sex, baseline age, anti-citrullinated peptide antibody status, current smoking, disease activity score- C-reactive protein (DAS28-CRP), and treatment randomization. The outcomes for this report were: DAS28-CRP ≤3.2 (DAS28-CRP low disease activity), DAS28-CRP ≤2.6 (DAS28-CRP remission) and clinical disease activity index (CDAI) ≤2.8 (CDAI remission).

Results In total, 75 (19%) participants had obesity at baseline, defined as body mass index (BMI) ≥30 kg/m2. The percentage of patients with obesity in each treatment group was (1) 25%, (2) 15%, (3) 19% and (4) 19%. At baseline, there were no differences in terms of disease activity indices and inflammation parameters between patients with BMI <30 vs. ≥30 kg/m2, except for the number of swollen joints (SJC28), which was slightly lower in those with obesity (mean+SD, 8±5 vs. 9±5, p=0.018). At 24-week follow-up, patients with obesity had higher disease activity indices and inflammation parameters compared to patients with lower BMI (Table 1). Moreover, patients with obesity had a lower chance of achieving response to treatment as measured by DAS28-CRP ≤3.2 (OR 0.5, 95% CI 0.2 - 0.9, p=0.025), DAS28-CRP ≤2.6 (OR 0.4, 95% CI 0.2 - 0.6, p <0.001) and CDAI remission (OR 0.4, 95% CI 0.2 - 0.8, p=0.006), compared to patients with lower BMI (Figure 1). BMI-treatment interaction was not significant for any score of disease activity.

Conclusion In patients with early RA, obesity was not associated with higher disease activity before treatment initiation. However, 24 weeks after treatment, patients with obesity had higher disease activity and lower chances to respond to therapy compared to patients with lower BMI irrespective of treatment.

View this table:
Table 1.

Disease activity scores and inflammatory parameters at 24 weeks follow-up stratified by baseline BMI

Figure 1.
Figure 1.

Multivariable binary logistic regression analysis for response to treatment at 24 weeks (reference category: BMI< 30 kg/m2)

References [1]Smolen, J.S., et al., Ann Rheum Dis, 2022. doi: 10.1136/ard-2022-223356

[2]Liu, Y., et al., Arthritis Care Res (Hoboken), 2017. doi: 10.1002/acr.22932.

[3]Dey, M., et al., Rheumatology (Oxford), 2021. doi: 10.1093/rheumatology/keab389.

[4]Hetland, M.L., et al., BMJ, 2020. doi: 10.1136/bmj.m4328.

Acknowledgements We would like to acknowledge the NORD-STAR Study group.

Disclosure of Interests Violetta Dubovyk: None declared, Gerdur Gröndal: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Nordic-Pharma, Consultant of: Novartis, Espen A Haavardsholm: None declared, Marte Heiberg: None declared, Merete Lund Hetland Grant/research support from: Research grants from Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Kim Hørslev-Petersen: None declared, Meliha C Kapetanovic: None declared, Alf Kastbom: None declared, Jon Lampa: None declared, Kristina Lend: None declared, Dan Nordström: None declared, Michael Nurmohamed: None declared, Milad Rizk: None declared, Annika Söderbergh Consultant of: Roche, Grant/research support from: Roche, Till Uhlig Consultant of: Consultant for Pfizer and UCB., Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, MEDAC, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB., Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, MEDAC, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Mikkel Østergaard has received research grants from Abbvie, BMS, Merck, Novartis and UCB, Ronald van Vollenhoven Speakers bureau: Speaker, for which institutional and/or personal honoraria were received: AbbVie, AstraZeneca, BMS, Galapagos, GSK, Janssen, Pfizer, UCB., Consultant of: Consultancy, for which institutional and/or personal honoraria were received: AbbVie, AstraZeneca, Biogen, BMS, Galapagos, Janssen, Pfizer, UCB., Grant/research support from: Research Support (institutional grants): BMS, UCB.

Support for Educational programs (institutional grants): MSD, Novartis, Pfizer, Roche, Sanofi, UCB

, Anna Rudin: None declared, Cristina Maglio: None declared.

  • Randomized control trial
  • Prognostic factors
  • Rheumatoid arthritis

https://doi.org/10.1136/annrheumdis-2023-eular.3036

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