title: TNFα blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: a 2-year prospective study.
abstract: OBJECTIVE
  To evaluate the long-term consequences of TNFα inhibitors on body composition and fat distribution, as well as changes in serum adipokines in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS).
  
  
  METHODS
  Eight patients with RA and twelve with AS requiring a TNFα inhibitor were prospectively followed for 2 years. Body composition was evaluated by dual X-ray absorptiometry and included measurements of total fat mass, lean mass, fat in the gynoid and android regions, and visceral fat. Serum leptin, total and high molecular weight (HMW) adiponectin, resistin, and ghrelin were also assessed.
  
  
  RESULTS
  There was a significant gain in body mass index (p = 0.05) and a tendency for weight (p = 0.07), android fat (p = 0.07), and visceral fat (p = 0.059) increase in patients with RA, while in AS, total fat mass significantly increased (p = 0.02) with a parallel weight gain (p = 0.07). When examining the whole population of patients, we observed after 2 years a significant increase in body weight (+1.9%; p = 0.003), body mass index (+2.5%; p = 0.004), total fat mass (+11.1%; p = 0.007), and fat in the android region (+18.3%; p = 0.02). There was a substantial, albeit nonsignificant gain in visceral fat (+24.3%; p = 0.088). Lean mass and gynoid fat were not modified. No major changes were observed for serum leptin, total adiponectin, and ghrelin, while HMW adiponectin and the HMW/total adiponectin ratio tended to decrease (-15.2%, p = 0.057 and -9.3%, p = 0.067, respectively). Resistin decreased significantly (-22.4%, p = 0.01).
  
  
  CONCLUSIONS
  Long-term TNFα inhibition in RA and AS is associated with a significant gain in fat mass, with a shift to the android (visceral) region. This fat redistribution raises questions about its influence on the cardiovascular profile of patients receiving these treatments.
authors.affiliation: Clinical Investigation Center for Biotherapy (INSERM CBT-506), University Hospital of Besançon, Bâtiment St Joseph, 2 Place St Jacques, 25000, Besançon, France, etoussirot@chu-besancon.fr.
authors.forename: Éric
authors.initials: É
authors.lastname: Toussirot
authors.forename: Laurent
authors.initials: L
authors.lastname: Mourot
authors.forename: Barbara
authors.initials: B
authors.lastname: Dehecq
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Émilie
authors.initials: É
authors.lastname: Grandclément
authors.forename: Gilles
authors.initials: G
authors.lastname: Dumoulin
mesh_terms: D050153:Abdominal Fat / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D052242:Adiponectin / Q000037:antagonists & inhibitors / Q000097:blood / Q000378:metabolism; D050154:Adiposity / Q000187:drug effects*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D015992:Body Mass Index; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052243:Resistin / Q000037:antagonists & inhibitors / Q000097:blood / Q000378:metabolism; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D015430:Weight Gain / Q000187:drug effects
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; C499624:RETN protein, human; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha