High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis

Ofir Elalouf,1,2 Merav Lidar,2,3 Tatiana Reitblat,4 Devy Zisman,5 Alexandra Balbir-Gurman,6 Odelia Hakakian,1 Tanya Mashiach,7 Ronit Almog,7 Ori Elkayam1,2 1Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Is...

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Autores principales:	Elalouf O, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Hakakian O, Mashiach T, Almog R, Elkayam O
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	tnf alpha biologics bmi obesity survival Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/ec4ae25745664039b5deecad613b5a13
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spelling	oai:doaj.org-article:ec4ae25745664039b5deecad613b5a132021-12-02T17:55:05ZHigh Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis1177-5491https://doaj.org/article/ec4ae25745664039b5deecad613b5a132021-07-01T00:00:00Zhttps://www.dovepress.com/high-body-mass-index-is-associated-with-shorter-retention-of-tumor-nec-peer-reviewed-fulltext-article-BTThttps://doaj.org/toc/1177-5491Ofir Elalouf,1,2 Merav Lidar,2,3 Tatiana Reitblat,4 Devy Zisman,5 Alexandra Balbir-Gurman,6 Odelia Hakakian,1 Tanya Mashiach,7 Ronit Almog,7 Ori Elkayam1,2 1Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; 4Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel; 5Department of Rheumatology, Carmel Medical Center, Haifa, Israel; 6Rheumatology Institute; 7Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, IsraelCorrespondence: Ofir ElaloufDepartment of Rheumatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, IsraelTel +972524262682Fax +97235422904Email ofire@tlvmc.gov.ilPurpose: To evaluate the association between body mass index (BMI) and tumor necrosis factor α (TNF-α) blockers retention in patients with rheumatoid arthritis (RA).Patients and Methods: This prospective cohort study analyzed data about patients with RA who initiated TNF blockers from the Israeli registry of inflammatory diseases from 2011 to 2019. Patients were grouped by BMI: normal (BMI < 24.9 kg/m2), overweight (BMI 25– 29.9 kg/m2), obese (BMI 30– 34.9 kg/m2) and morbid obese (BMI ≥ 35 kg/m2). Treatment cessation due to inefficacy was defined as an “event” and therapy with a drug above 3 months was defined as a “course.” Kaplan–Meier survival curve was used to describe drug survival. Event-free survival was calculated using Cox regression with a hazard ratio and confidence interval of 95%.Results: The final analysis included 521 RA patients (80% females) treated with etanercept, infliximab, adalimumab or golimumab. Eight hundred and eighteen treatment initiations were included in the final analysis, 334 (41%) in the normal weight group, 261 (32%) in the overweight, 144 (17%) in the obese and 79 (10%) in the morbid obesity group. Three hundred and twenty-six (40%) treatment initiations were with etanercept, 215 (26%) with adalimumab 197 (24%) with infliximab, and 80 (10%) with golimumab. BMI was inversely associated with drug survival. Morbid obese patients were more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67– 3.10, p< 0.01). This association remained significant for each drug type (except for golimumab) in a subgroup analysis. Adalimumab switch rate was higher compared to etanercept with HR =1.51 (95% CI 1.20– 1.91, p< 0.01), no other significant differences were noted between the other drugs.Conclusion: Morbid obese RA patients have lower TNF-α blocker retention compared to normal weight patients.Keywords: TNF alpha, biologics, BMI, obesity, survivalElalouf OLidar MReitblat TZisman DBalbir-Gurman AHakakian OMashiach TAlmog RElkayam ODove Medical Pressarticletnf alphabiologicsbmiobesitysurvivalMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol Volume 15, Pp 279-287 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	tnf alpha biologics bmi obesity survival Medicine (General) R5-920
spellingShingle	tnf alpha biologics bmi obesity survival Medicine (General) R5-920 Elalouf O Lidar M Reitblat T Zisman D Balbir-Gurman A Hakakian O Mashiach T Almog R Elkayam O High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
description	Ofir Elalouf,1,2 Merav Lidar,2,3 Tatiana Reitblat,4 Devy Zisman,5 Alexandra Balbir-Gurman,6 Odelia Hakakian,1 Tanya Mashiach,7 Ronit Almog,7 Ori Elkayam1,2 1Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; 4Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel; 5Department of Rheumatology, Carmel Medical Center, Haifa, Israel; 6Rheumatology Institute; 7Epidemiology and Biostatistics Unit, Rambam Health Care Campus, Haifa, IsraelCorrespondence: Ofir ElaloufDepartment of Rheumatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, IsraelTel +972524262682Fax +97235422904Email ofire@tlvmc.gov.ilPurpose: To evaluate the association between body mass index (BMI) and tumor necrosis factor α (TNF-α) blockers retention in patients with rheumatoid arthritis (RA).Patients and Methods: This prospective cohort study analyzed data about patients with RA who initiated TNF blockers from the Israeli registry of inflammatory diseases from 2011 to 2019. Patients were grouped by BMI: normal (BMI < 24.9 kg/m2), overweight (BMI 25– 29.9 kg/m2), obese (BMI 30– 34.9 kg/m2) and morbid obese (BMI ≥ 35 kg/m2). Treatment cessation due to inefficacy was defined as an “event” and therapy with a drug above 3 months was defined as a “course.” Kaplan–Meier survival curve was used to describe drug survival. Event-free survival was calculated using Cox regression with a hazard ratio and confidence interval of 95%.Results: The final analysis included 521 RA patients (80% females) treated with etanercept, infliximab, adalimumab or golimumab. Eight hundred and eighteen treatment initiations were included in the final analysis, 334 (41%) in the normal weight group, 261 (32%) in the overweight, 144 (17%) in the obese and 79 (10%) in the morbid obesity group. Three hundred and twenty-six (40%) treatment initiations were with etanercept, 215 (26%) with adalimumab 197 (24%) with infliximab, and 80 (10%) with golimumab. BMI was inversely associated with drug survival. Morbid obese patients were more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67– 3.10, p< 0.01). This association remained significant for each drug type (except for golimumab) in a subgroup analysis. Adalimumab switch rate was higher compared to etanercept with HR =1.51 (95% CI 1.20– 1.91, p< 0.01), no other significant differences were noted between the other drugs.Conclusion: Morbid obese RA patients have lower TNF-α blocker retention compared to normal weight patients.Keywords: TNF alpha, biologics, BMI, obesity, survival
format	article
author	Elalouf O Lidar M Reitblat T Zisman D Balbir-Gurman A Hakakian O Mashiach T Almog R Elkayam O
author_facet	Elalouf O Lidar M Reitblat T Zisman D Balbir-Gurman A Hakakian O Mashiach T Almog R Elkayam O
author_sort	Elalouf O
title	High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
title_short	High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
title_full	High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
title_fullStr	High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
title_full_unstemmed	High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis
title_sort	high body mass index is associated with shorter retention of tumor necrosis factor-alpha blocker treatment in rheumatoid arthritis
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/ec4ae25745664039b5deecad613b5a13
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High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis

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