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BMI dictated efficacy of infliximab in patients with ankylosing spondylitis
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A higher BMI negatively affected response to infliximab for patients with ankylosing spondylitis in a recent study.
Researchers performed a retrospective study of 155 patients diagnosed with ankylosing spondylitis (AS). Before receiving 5 mg/kg infliximab (IFX) intravenously (every 6 weeks for 6 months), each patient’s BMI was calculated, along with their Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pain visual analog scale (VAS), use of nonsteroidal anti-inflammatory drugs (NSAIDs), HLA B27 status and C-reactive protein (CRP) level. BMI was defined as normal (<25 kg/m2), overweight (25-30mg/m2) or obese (>30 kg/m2).
After 6 months of IFX therapy, changes from baseline were separated with a threshold corresponding to a decrease of 50% of the initial level into variables corresponding to the responses to IFX (BASDAI 50, VAS 50, CRP 50, NSAID 50).
Using multivariate analysis researchers found that a higher BMI was statistically significant with a lower response for BASDAI 50 (OR=0.87; 95% CI, 0.81-0.94), VAS 50 (OR=0.87; 95% CI, 0.80-0.93), CRP 50 (OR=0.93; 95% CI, 0.88-0.99) and NSAID 50 (OR=0.91; 95% CI, 0.85-0.97).
Additionally, based on the three BMI categories, similar responses were observed for BASDAI 50 (77.6% normal, 48.9% overweight, 26.5% obese; all P<.0001), VAS 50 (72.6%, 40.4%, 16.7%; all P<.0001) and CRP 50 (87.5%, 65.7%, 38.5%; all P<.0001). NSAID 50 responders also showed decreases as BMI rose although they did not reach statistical significance (63.2%, 51.5%, 34.6%; P=.06).
“This study provides the first evidence that a higher BMI negatively influences the response to IFX in AS,” researchers concluded. “Further prospective studies [including assessment of the fat mass, pharmacokinetics and adipocytokines dosages] are now required to determine how this must be taken into account for the treatment of [rheumatoid arthritis] and AS patients with IFX and probably other biologic agents.”
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