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Effect of Disease Activity, Glucocorticoid Exposure, and Rituximab on Body Composition During Induction Treatment of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

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Wallace ZS1, Miloslavsky EM1, Cascino M1, Unizony SH1, Lu N1, Hoffman GS2, Kallenberg CGM3, Langford CA2, Merkel PA4, Monach PA5, Seo P6, Spiera R7, St Clair EW8, Specks U9, Brunetta P10, Choi HK1, Stone JH1. Arthritis Care Res (Hoboken). 2017 Jul;69(7):1004-1010. doi: 10.1002/acr.23099.

Abstract

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1 Massachusetts General Hospital, Boston.

2 Cleveland Clinic Foundation, Cleveland, Ohio.

3 Universiteit Groningen, Groningen, The Netherlands.

4 University of Pennsylvania, Philadelphia.

5 Boston Medical Center, Boston University, Boston, Massachusetts.

6 Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland.

7 Hospital for Special Surgery, New York, New York.

8 Duke University, Durham, North Carolina.

9 Mayo Clinic, Rochester, Minnesota.

10 Genentech, San Francisco, California.

Abstract OBJECTIVE:

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).

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.