title: Effect of Disease Activity, Glucocorticoid Exposure, and Rituximab on Body Composition During Induction Treatment of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
abstract: We investigated the relationships between glucocorticoid use, disease activity, and changes in body mass index (BMI) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
  
  
  
  We analyzed AAV patients enrolled in the Rituximab in AAV trial. Glucocorticoid use, BMI, and disease activity were measured regularly during the trial period. We performed mixed-effects regressions to examine the associations of time-dependent cumulative average glucocorticoid use and disease activity with changes in BMI over time, while adjusting for potential confounders.
  
  
  
  The mean ± SD baseline BMI of the 197 patients enrolled was 28.8 ± 6.3 kg/m2. Patients with newly diagnosed AAV tended to have a lower mean ± SD BMI than those with relapsing disease (28.0 ± 5.7 kg/m2versus 29.6 ± 6.8 kg/m2) and higher disease activity (mean ± SD Birmingham Vasculitis Activity Score for Wegener's Granulomatosis 8.7 ± 3.3 versus 7.4 ± 2.7). The most significant change in BMI occurred during the first 6 months of the trial (mean ± SD increase of 1.1 ± 2.2 kg/m2; P < 0.0001). Disease activity improvement, glucocorticoid exposure, and randomization to rituximab were each independently associated with an increase in BMI (P < 0.001 for all analyses).
  
  
  
  Our findings suggest that changes in BMI, as well as glucocorticoid exposure, are independently associated with improvements in disease activity in AAV. Rituximab may also have effects on BMI independent of its impact on disease activity.
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Wallace
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Eli M
authors.initials: EM
authors.lastname: Miloslavsky
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cascino
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Sebastian H
authors.initials: SH
authors.lastname: Unizony
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Hoffman
authors.affiliation: Universiteit Groningen, Groningen, The Netherlands.
authors.forename: Cees G M
authors.initials: CGM
authors.lastname: Kallenberg
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Langford
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
authors.affiliation: Boston Medical Center, Boston University, Boston, Massachusetts.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Monach
authors.affiliation: Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Spiera
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: E William
authors.initials: EW
authors.lastname: St Clair
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Specks
authors.affiliation: Genentech, San Francisco, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Brunetta
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: John H
authors.initials: JH
authors.lastname: Stone
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001823:Body Composition / Q000187:drug effects* / Q000502:physiology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D000069283:Rituximab / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D000069283:Rituximab