title: Body weight, gender and response to TNF-α blockers in axial spondyloarthritis.
abstract: OBJECTIVE
  The objective of this study was to determine whether BMI and gender could lead to a different response rate to anti-TNF agents in patients affected by axial SpA.
  
  
  METHODS
  One hundred and seventy patients with active axial SpA (defined as a BASDAI ≥ 4) treated with an anti-TNF agent [adalimumab (ADA), etanercept (ETA), infliximab (IFX)] were retrospectively evaluated. Patients were divided according to the baseline BMI as normal weight (BMI < 25), overweight (BMI 25-30) and obese (BMI ≥ 30). After 12 months of treatment a 50% improvement of the initial BASDAI (BASDAI50) was the primary end point and BASDAI ≤ 1 was the secondary end point.
  
  
  RESULTS
  After 12 months of anti-TNF treatment, 67.8% of men and 46.2% of women reached the BASDAI50 (P = 0.01). According to BMI categories, the rate of BASDAI50 achievement decreased from 72.8% in normal weight subjects to 54.5% in overweight and 30.4% in obese subjects (P < 0.001). In the logistic regression analysis, the best independent predictors of failure to obtain a BASDAI50 response at the 12th month of therapy in axial SpA patients were female gender [odds ratio (OR) 3.23 (95% CI 1.52, 7.14)] and a BMI ≥ 30 [OR 3.57 (95% CI 1.15, 11.11)]. Analysing outcomes based on IFX therapy (the larger subgroup), the BASDAI50 response rate fell from 79.0% in normal weight subjects to 56.7% in overweight and 16.7% in obese subjects (P < 0.001). No significant differences were observed with ADA and ETA.
  
  
  CONCLUSIONS
  Data suggest that being female, overweight and mostly obese is associated with a lower rate of success in obtaining response status in axial SpA patients treated with anti-TNF drugs. Body weight could represent a modifiable factor to reach the best outcome in axial SpA patients treated with TNF blockers.
authors.affiliation: Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, CIC-Via Moscati 31, 00168, Rome, Italy. gf.ferraccioli@rm.unicatt.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.forename: Simone
authors.initials: S
authors.lastname: Bernardi
authors.forename: Sara
authors.initials: S
authors.lastname: Bonazza
authors.forename: Marcin
authors.initials: M
authors.lastname: Nowik
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.forename: Alfonso
authors.initials: A
authors.lastname: Massara
authors.forename: Barbara
authors.initials: B
authors.lastname: Tolusso
authors.forename: Laura
authors.initials: L
authors.lastname: Messuti
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Miceli
authors.forename: Angelo
authors.initials: A
authors.lastname: Zoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Trotta
authors.forename: Marcello
authors.initials: M
authors.lastname: Govoni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001368:Axis, Cervical Vertebra; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D012737:Sex Factors; D025241:Spondylarthritis / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: BMI; anti-TNF response; axial spondyloarthritis; gender; obesity