Obesity dampens rheumatoid arthritis treatment effectiveness, satisfaction
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SAN DIEGO — Obesity represents a significant barrier to treatment effectiveness, and by extension treatment satisfaction, in rheumatoid arthritis, according to data presented at the 2024 Congress of Clinical Rheumatology West.
“Treatment satisfaction among patients is really important,” Anja Strangfeld, MD, PhD, head of epidemiology and health services research at the German Rheumatology Research Center, in Berlin, told attendees. “If they’re not satisfied, they’re not adherent, and they will not take their prescribed medication.”
Strangfeld shared data from RABBIT, a registry of more than 23,000 patients with RA in Germany that has been running since 2001.
An analysis of treatment satisfaction among 10,646 patients (mean age, 58 years) found unexpectedly positive results, according to Strangfeld. At baseline, 55% were satisfied with the effectiveness of their treatment. That figure increased to 85% at 1 year, with 90% also being satisfied with treatment tolerability at that time point.
“We were surprised,” Strangfeld said. “A lot of patients were really satisfied with their treatment.”
The “high level of satisfaction” was primarily driven by those who were already satisfied at baseline, and those with significant reductions in disease activity, Strangfeld added. The glucocorticoid regimen was also a considerable factor.
“If treatment with glucocorticoids can be reduced, then this increases treatment satisfaction a lot,” she said. “Among the factors that have a significant impact on patient satisfaction, we have the most influence on glucocorticoid therapy.”
Meanwhile, depression, fibromyalgia and obesity were associated with less satisfaction in both the effectiveness and tolerability of treatment, according to Strangfeld.
“We should address those comorbidities to reach a better treatment satisfaction and treatment effectiveness,” she said.
Another study of RABBIT data found obesity reducing not only treatment satisfaction, but also treatment effectiveness, Strangfeld added.
“Obesity influenced mainly the treatment effectiveness in cytokine-targeted and conventional synthetic DMARD treatments but did not effect in the same range the treatments with cell-targeted therapy — abatacept and rituximab,” she said. “What we also found was a clear gender-specific difference — obesity in women had a much greater impact on treatment effectiveness than in men.”
According to Strangfeld, obesity worsened multiple effectiveness measures, particularly in women, including the DAS28, the Patient Global Health Assessment, C-reactive protein levels and physical function.
“We think obesity is something that we really have to take care of,” Strangfeld said. “For me, it’s something like a good biomarker that you see immediately. You don’t have to draw blood, and you can decide which treatment would be better for this patient.”
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Strangfeld A. Clinical Outcomes in Rheumatoid Arthritis from the German RABBIT Register. Presented at The Congress of Clinical Rheumatology West; Sept. 26-29, 2024. (hybrid meeting).
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