abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis

Author information

McCulley CB1, Barton JL2, Cannon GW3, Sauer BC3, Teng CC3, George MD4, Caplan L5, England BR6, Mikuls TR6, Baker JF7. Clin Exp Rheumatol. 2018 Nov 7. [Epub ahead of print]


Author information 1 VA Portland Health Care System; Oregon Health & Science University, OR, USA. caroline.bonafede@gmail.com. 2 VA Portland Health Care System; Oregon Health & Science University, OR, USA. 3 VA Salt Lake City Healthcare System; University of Utah; Salt Lake City VA Medical Center (IDEAS 2.0) University of Utah, Division of Epidemiology, Team VERITAS, OR, USA. 4 Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA. 5 Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, USA. 6 VA Nebraska-Western Iowa Health Care Center and the University of Nebraska Medical Center, Omaha, NE, USA. 7 Division of Rheumatology, University of Pennsylvania, Philadelphia, and Corporal Michael C. Crescenz VA Medical Center, Philadelphia, PA, USA.

Abstract OBJECTIVES: Obese patients with rheumatoid arthritis (RA) may be more likely to discontinue therapy than non-obese patients, possibly signifying a more refractory phenotype. The purpose of this study was to examine the association between body mass index (BMI) and discontinuation rates for different RA treatments accounting for confounding factors.

METHODS: Veterans Affairs administrative databases were used to define initial courses of methotrexate (MTX), hydroxychloroquine, sulfasalazine, prednisone, and self-injectable tumour necrosis factor inhibitors (TNFi). Discontinuation was defined as a lapse in drug refill >90 days. Using overweight BMI (25-30 kg/m2) as the referent group, multivariable Cox proportional hazards models were used to evaluate associations between BMI category and time to treatment discontinuation.

RESULTS: There were 46,970 initial RA treatment courses identified from 2005-2014 among 23,669 Veterans with RA. In multivariable models, severe obesity (BMI >35 kg/m2), compared to overweight BMI, was not associated with treatment discontinuation with the exception of prednisone [HR 1.10 (1.04, 1.17) p<0.001]. Patients with low (<20 kg/m2) and normal BMI (20-25 kg/m2) were more likely to discontinue MTX, TNFi, and HCQ compared to overweight patients. Other factors associated with earlier MTX and/or TNFi discontinuation included female sex, black race, greater comorbidity, depression, malignancy, congestive heart failure, current smoking, and more recent calendar year.

CONCLUSIONS: Obesity was not associated with therapy discontinuation among veterans with RA after accounting for confounding factors, suggesting that obesity is not a biological mediator of more refractory disease. Conversely, low BMI, comorbidity, and depression were identified as important predictors of drug discontinuation.