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Weight Loss or Gain Varied by Disease-Modifying Treatment for Patients With RA
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Results of a recently published study of patients with rheumatoid arthritis identified in the U.S. Department of Veterans Affairs database showed leflunomide was associated with modest weight loss, while the use of prednisone was linked with greater weight gain compared to other treatments.
Researchers identified 52,662 treatment courses for 32,859 patients with rheumatoid arthritis (RA) and compared BMI changes from 6 months following a prescription fill with methotrexate, prednisone, leflunomide and tumor necrosis factor inhibitors (TNFi).
Overall, 31% of patients who received leflunomide displayed weight loss at 6 months. In models adjusted for sex, disease activity measures and other variables and in unadjusted analysis, leflunomide was associated with weight loss. However, investigators found prednisone, methotrexate and TNFi were associated with increases in BMI.
Greater increases in BMI were observed in patients with RA who received prednisone compared to patients who received methotrexate. Concomitant use of prednisone with methotrexate, TNFi and leflunomide was also associated with increased BMI and did not differ by patient sex or race, but improvements in C-reactive protein (CRP) levels were associated with increases in BMI at 6 months compared to patients who did not have significant changes in CRP. Prednisone use remained a significant factor in weight gain after adjusting for weight gain or loss in the prior 12 months. Changes in weight were similar in proportion to patients who received methotrexate, however, multivariate and single variable analysis models showed no association between the use of TNFi and changes in BMI.
Older age, higher baseline CRP, less improvement in CRP levels at 6 months, higher baseline BMI, the presence of anti-citrullinated peptide antibodies, a disease duration of more than 5 years and a history of lung disease or malignancy were associated with weight loss identified by the researchers. More weight gain was observed in patients who had previously lost weight in the year prior to treatment. Current smokers were more likely to lose weight following treatment.
Disclosure: The researchers report funding from a Veterans Affairs Clinical Science Research and Development Career Development Award (IK2-CX000955, a K24 Mid-Career Development Award from the National Institutes of Musculoskeletal and Skin Disorders (1K24-AR-055259-01), and a Veterans Affairs Merit Award.
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Baker JF. Arth & Rheumatol. 2016;doi:10.1002.
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