Obesity Hinders Remission In RA, but Infliximab Helps

BOSTON — Overweight patients with early rheumatoid arthritis were less likely to achieve remission with conventional disease-modifying drugs than patients with a normal body mass index.

Overweight and obese patients fared better if they were treated with a regimen that also included infliximab, Dr. Marjatta Leirisalo-Repo said at the annual meeting of the American College of Rheumatology.

The study enrolled 100 patients with RA of less than 1 year's duration from 15 centers, and randomized them to methotrexate, sulfasalazine, hydroxychloroquine, and prednisone plus either infliximab or placebo for 6 months.

Patients' mean age was 46 years, median duration of symptoms was 4 months, mean number of swollen joints was 15, and mean number of tender joints was 20. All participants had morning stiffness lasting 45 minutes or more.

At baseline, the mean erythrocyte sedimentation rate (ESR) was 33 mm/h and the mean Health Assessment Questionnaire (HAQ) score was 1.

In all, 67% of patients were female and 68% were rheumatoid factor positive. None of the patients had previously been treated with a disease-modifying antirheumatic drug (DMARD).

The DMARD regimens were individually tailored, with maximum dosages of methotrexate of 25 mg/week and maximum dosages of sulfasalazine of 2 g/day. Hydroxychloroquine was given in dosages of 35 mg/kg per week and prednisone in 7.5 mg/day. Patients randomized to also receive infliximab received it in dosages of 3 mg/kg at weeks 4, 6, 10, 18, and 26.

Remission was defined as early-morning stiffness lasting less than 15 minutes; no fatigue, joint pain, or swollen or tender joints; and an ESR less than 30 mm/hour.

At 6 months, 53% of patients had achieved remission, said Dr. Leirisalo-Repo, professor of rheumatology at Helsinki University Central Hospital and the University of Helsinki.

The percentages of patients in remission at 6 months in the infliximab and placebo groups were 58% and 47%, respectively. At 12 months, the corresponding percentages were 58% and 52%.

At 6 months, 63% of placebo patients whose body mass index (BMI) was less than 25 kg/m

“No such association was seen in the infliximab-treated patients,” Dr. Leirisalo-Repo said. Remission rates in the normal, overweight, and obese groups receiving the biologic agent at 6 months were 55%, 68%, and 46%, respectively.

At 12 months, the remission rates for normal, overweight, and obese patients in the placebo group were 58%, 35%, and 25%, whereas those in the infliximab group were 45%, 74%, and 55%.

It appears obesity is associated with a lack of response to conventional DMARDs, even when these drugs are given in combination, but infliximab was able to overcome this DMARD resistance, Dr. Leirisalo-Repo said. “Fat is proinflammatory, and obesity is characterized by systemic inflammation,” she said in a press conference.

Dr. Leirisalo-Repo disclosed that she has received research grants from Schering-Plough Oy in Finland.

BOSTON — Overweight patients with early rheumatoid arthritis were less likely to achieve remission with conventional disease-modifying drugs than patients with a normal body mass index.

Overweight and obese patients fared better if they were treated with a regimen that also included infliximab, Dr. Marjatta Leirisalo-Repo said at the annual meeting of the American College of Rheumatology.

The study enrolled 100 patients with RA of less than 1 year's duration from 15 centers, and randomized them to methotrexate, sulfasalazine, hydroxychloroquine, and prednisone plus either infliximab or placebo for 6 months.

Patients' mean age was 46 years, median duration of symptoms was 4 months, mean number of swollen joints was 15, and mean number of tender joints was 20. All participants had morning stiffness lasting 45 minutes or more.

At baseline, the mean erythrocyte sedimentation rate (ESR) was 33 mm/h and the mean Health Assessment Questionnaire (HAQ) score was 1.

In all, 67% of patients were female and 68% were rheumatoid factor positive. None of the patients had previously been treated with a disease-modifying antirheumatic drug (DMARD).

The DMARD regimens were individually tailored, with maximum dosages of methotrexate of 25 mg/week and maximum dosages of sulfasalazine of 2 g/day. Hydroxychloroquine was given in dosages of 35 mg/kg per week and prednisone in 7.5 mg/day. Patients randomized to also receive infliximab received it in dosages of 3 mg/kg at weeks 4, 6, 10, 18, and 26.

Remission was defined as early-morning stiffness lasting less than 15 minutes; no fatigue, joint pain, or swollen or tender joints; and an ESR less than 30 mm/hour.

At 6 months, 53% of patients had achieved remission, said Dr. Leirisalo-Repo, professor of rheumatology at Helsinki University Central Hospital and the University of Helsinki.

The percentages of patients in remission at 6 months in the infliximab and placebo groups were 58% and 47%, respectively. At 12 months, the corresponding percentages were 58% and 52%.

At 6 months, 63% of placebo patients whose body mass index (BMI) was less than 25 kg/m

“No such association was seen in the infliximab-treated patients,” Dr. Leirisalo-Repo said. Remission rates in the normal, overweight, and obese groups receiving the biologic agent at 6 months were 55%, 68%, and 46%, respectively.

At 12 months, the remission rates for normal, overweight, and obese patients in the placebo group were 58%, 35%, and 25%, whereas those in the infliximab group were 45%, 74%, and 55%.

It appears obesity is associated with a lack of response to conventional DMARDs, even when these drugs are given in combination, but infliximab was able to overcome this DMARD resistance, Dr. Leirisalo-Repo said. “Fat is proinflammatory, and obesity is characterized by systemic inflammation,” she said in a press conference.

Dr. Leirisalo-Repo disclosed that she has received research grants from Schering-Plough Oy in Finland.

BOSTON — Overweight patients with early rheumatoid arthritis were less likely to achieve remission with conventional disease-modifying drugs than patients with a normal body mass index.

Overweight and obese patients fared better if they were treated with a regimen that also included infliximab, Dr. Marjatta Leirisalo-Repo said at the annual meeting of the American College of Rheumatology.

The study enrolled 100 patients with RA of less than 1 year's duration from 15 centers, and randomized them to methotrexate, sulfasalazine, hydroxychloroquine, and prednisone plus either infliximab or placebo for 6 months.

Patients' mean age was 46 years, median duration of symptoms was 4 months, mean number of swollen joints was 15, and mean number of tender joints was 20. All participants had morning stiffness lasting 45 minutes or more.

At baseline, the mean erythrocyte sedimentation rate (ESR) was 33 mm/h and the mean Health Assessment Questionnaire (HAQ) score was 1.

In all, 67% of patients were female and 68% were rheumatoid factor positive. None of the patients had previously been treated with a disease-modifying antirheumatic drug (DMARD).

The DMARD regimens were individually tailored, with maximum dosages of methotrexate of 25 mg/week and maximum dosages of sulfasalazine of 2 g/day. Hydroxychloroquine was given in dosages of 35 mg/kg per week and prednisone in 7.5 mg/day. Patients randomized to also receive infliximab received it in dosages of 3 mg/kg at weeks 4, 6, 10, 18, and 26.

Remission was defined as early-morning stiffness lasting less than 15 minutes; no fatigue, joint pain, or swollen or tender joints; and an ESR less than 30 mm/hour.

At 6 months, 53% of patients had achieved remission, said Dr. Leirisalo-Repo, professor of rheumatology at Helsinki University Central Hospital and the University of Helsinki.

The percentages of patients in remission at 6 months in the infliximab and placebo groups were 58% and 47%, respectively. At 12 months, the corresponding percentages were 58% and 52%.

At 6 months, 63% of placebo patients whose body mass index (BMI) was less than 25 kg/m

“No such association was seen in the infliximab-treated patients,” Dr. Leirisalo-Repo said. Remission rates in the normal, overweight, and obese groups receiving the biologic agent at 6 months were 55%, 68%, and 46%, respectively.

At 12 months, the remission rates for normal, overweight, and obese patients in the placebo group were 58%, 35%, and 25%, whereas those in the infliximab group were 45%, 74%, and 55%.

It appears obesity is associated with a lack of response to conventional DMARDs, even when these drugs are given in combination, but infliximab was able to overcome this DMARD resistance, Dr. Leirisalo-Repo said. “Fat is proinflammatory, and obesity is characterized by systemic inflammation,” she said in a press conference.

Dr. Leirisalo-Repo disclosed that she has received research grants from Schering-Plough Oy in Finland.