Medication-assisted weight loss boosts patient-reported outcomes in rheumatic disease
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WASHINGTON — Patients who use medication or surgery to achieve at least 5% weight loss demonstrate greater improvements in patient-reported outcomes across various rheumatic diseases, according to data presented at ACR Convergence 2024.
“GLP-1 agonist use has been expanding as an effective medical therapy for weight loss,” Thomas Riley, MD, a postdoctoral fellow at the University of Pennsylvania, in Philadelphia, told attendees. “About 33% of patients are able to achieve this 5% weight loss target at 72 weeks. Given this is a new, effective therapy for weight loss, we were wondering, is this 5% weight loss associated with improvements in patient-reported outcomes or patient-reported disease activity scores in patients with autoimmune or musculoskeletal diseases?”
To evaluate these questions, Riley and colleagues analyzed patient data from the FORWARD Databank, which contains questionnaires completed every 6 months by adult patients at U.S. community-based rheumatology practices. The analysis included patients who reported using a medication associated with weight loss between January 2005 and June 2023.
The study compared pain, fatigue and other patient-reported outcomes between patients receiving therapies associated with weight loss who achieved 5% or greater weight loss over a 6-month period vs. those who did not. Weight loss therapies in the study included GLP-1 agonists, metformin, appetite suppressants and bariatric surgery.
The researchers assessed relationships between weight loss and patient-reported outcomes using linear regression and linear models with generalized estimating equations, clustered by patient and adjusted for demographic and clinical factors.
The final analysis included 3,868 participants and a total of 24,484 instances where weight change could be calculated across 6 months, 10.5% of which involved weight loss of 5%. Rheumatic diseases within the cohort included rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, osteoarthritis and fibromyalgia.
In both adjusted and unadjusted analyses, 5% weight loss was associated with statistically significant improvements in:
- Patient Activity Scale II (adjusted B = –0.12; 95% CI, –0.17 to –0.067);
- Patient Global assessment (adjusted B = –0.12; 95% CI, –0.2 to –0.044);
- pain scale (adjusted B = –0.2; 95% CI, –0.28 to –0.12);
- fatigue scale (adjusted B = –0.086; 95% CI, –0.17 to –0.005);
- polysymptomatic distress (adjusted B = –0.45; 95% CI, –0.68 to –0.23); and
- Short-Form 36 physical component score (adjusted B = –0.44; 95% CI, –0.16 to 0.72).
According to the researchers, a test for effect modification revealed a greater likelihood of change in Patient Activity Scale II (PAS-II) — which is a composite of Health Assessment Questionnaire II, patient global assessment and pain scale — among patients with obesity, regardless of diagnosis.
“Among those reporting the use of weight loss therapies, 5% weight loss is associated with statistically significant improvements in patient-reported outcomes and the PAS-II,” Riley said. “Those with obesity, really regardless of their underlying condition, are noting improvements in their disease activity. These observations can inform randomized controlled trials to target some of these conditions that may be more likely to see benefits, and to assess if medication-assisted weight loss therapy can really improve patient symptoms and disease activity scores.”
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Riley T. Abstract #0845. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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