Poor clinical, ultrasonographic responses seen in obese RA patients treated with ADA, MTX
Clinical and ultrasonographic responses are worse in obese vs nonobese patients with rheumatoid arthritis (RA) treated with adalimumab (ADA) and methotrexate (MTX), suggests a recent study, adding that these are partly overcome with time.
“Obese patients may experience better and faster clinical improvements if ADA is initiated with high-dose (20 mg/week) rather than low-dose MTX,” the authors said.
This posthoc analysis of the MUSICA trial examined MTX 20 mg/week vs 7.5 mg/week in combination with ADA in RA patients with an inadequate response to MTX. The authors categorized patients by baseline body mass index as normal (<25 kg/m2), overweight (≥25 to <30 kg/m2), or obese (≥ 30 kg/m2).
The following were evaluated at weeks 12 and 24: synovial vascularity and hypertrophy, swollen (SJC) and tender joint counts (TJC), American College of Rheumatology (ACR) responses, and low disease activity (LDA), defined as Clinical Disease Activity Index <10 and 28-joint count Disease Activity Score using C-reactive protein (DAS28-CRP) <3.2.
There were similar patient characteristics at baseline among groups. From baseline to weeks 12 and 24, changes in SJC, TJC, DAS28-CRP, and synovial hypertrophy and vascularity were numerically smaller in obese vs nonobese patients.
There were significantly fewer obese patients who reached ACR20/50 at weeks 12 and 24, and LDA at week 12. This difference was particularly evident among those receiving 7.5 mg/week MTX but was no longer significant at week 24.
“Obese patients with RA report more joint swelling and tenderness and often have poorer responses to therapy than nonobese patients,” the authors said.