Sorbonne Paris Cité, Université Paris Diderot, Paris, France.
Service de Rhumatologie, Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Bichat, Paris, France.
Eur J Clin Invest. 2016 Dec;46(12):1048-1052. doi: 10.1111/eci.12691. Epub 2016 Nov 7.
Previous studies suggested that obesity could negatively affect the response to antitumour necrosis factor-α (TNFα) agents in rheumatoid arthritis (RA). However, data are lacking on whether obesity affects the response to abatacept (ABA). We aimed to determine whether body mass index (BMI) affects the response to ABA in RA.
In this multicenter retrospective study, we included RA patients who received ABA. BMI was calculated at the initiation of treatment. After 6 months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, tender and swollen joint count were analysed. The primary endpoint was decrease in DAS28 ≥ 1·2. Secondary outcomes were good response and remission by EULAR criteria.
At baseline, among 141 RA patients included, the median [interquartile range] BMI was 26·0 [22·9-30·8] kg/m². The number of patients with normal weight, overweight and obesity was 64 (45·4%), 38 (27%) and 39 (27·6%), respectively. Baseline characteristics did not differ among the three BMI subgroups. Univariate analysis revealed no difference in BMI between responders and nonresponders: DAS28 decrease ≥ 1·2 (25·0 [23·4-31·3] vs. 26·3 [22·9-30·2], P = 0·95), EULAR good response (26·4 [23·5-30·9] vs. 26·0 [22·9-30·6], P = 0·96) and remission (26·7 [21·7-30·3] vs. 26·0 [23·0-30·1], P = 0·83).
In our real-life study, BMI did not affect the response to ABA in RA. If confirmed, these results suggest that obesity is not a limitation of ABA use in RA.
之前的研究表明肥胖可能会对类风湿关节炎（RA）患者使用抗肿瘤坏死因子-α（TNFα）药物的反应产生负面影响。然而，目前尚缺乏关于肥胖是否会影响阿巴西普（ABA）反应的数据。我们旨在确定体重指数（BMI）是否会影响 RA 患者对 ABA 的反应。
在这项多中心回顾性研究中，我们纳入了接受 ABA 治疗的 RA 患者。在治疗开始时计算 BMI。治疗 6 个月后，分析从基线开始 DAS28、视觉模拟量表上的疼痛、红细胞沉降率和 C 反应蛋白水平、压痛和肿胀关节计数的变化。主要终点是 DAS28 降低≥1.2。次要结局是根据 EULAR 标准判断的良好反应和缓解。
在基线时，纳入的 141 例 RA 患者中，中位数[四分位距]BMI 为 26.0[22.9-30.8]kg/m²。体重正常、超重和肥胖的患者分别为 64 例（45.4%）、38 例（27%）和 39 例（27.6%）。三组 BMI 患者的基线特征无差异。单因素分析显示，反应者和无反应者的 BMI 无差异：DAS28 降低≥1.2（25.0[23.4-31.3]vs.26.3[22.9-30.2]，P=0.95）、EULAR 良好反应（26.4[23.5-30.9]vs.26.0[22.9-30.6]，P=0.96）和缓解（26.7[21.7-30.3]vs.26.0[23.0-30.1]，P=0.83）。
在我们的真实研究中，BMI 并不影响 RA 患者对 ABA 的反应。如果得到证实，这些结果表明肥胖并不是 RA 患者使用 ABA 的限制因素。
