Considering baseline obesity could improve chances of treat-to-target success in RA
medwireNews: Obesity is associated with a reduced likelihood of achieving remission among patients with moderately active rheumatoid arthritis (RA) treated with an intensive strategy, suggests an analysis of data from the TITRATE trial.
Initial findings from the study showed that 12 months of an intensive treat-to-target approach – involving monthly appointments with clinical assessment, dose adjustment, and psychosocial support – improved overall remission rates relative to standard care in this patient population, say Sook Yan Lee (King’s College London, UK) and colleagues.
However, “[t]here is growing recognition that many patients fail to respond to intensive treatments using treat-to-target approaches and understanding the reasons for treatment failure remains an important research objective,” they add.
To address this, Lee and team carried out a prespecified secondary analysis of data from 149 TITRATE participants given intensive management and 150 given standard care.
They identified “a strong relationship” between baseline obesity and rates of remission according to a DAS28-ESR below 2.6 points at 12 months. Specifically, among patients with available data, the average BMI was significantly lower among the 76 patients who achieved remission compared with the 223 who did not, at 25.8 versus 29.1 kg/m2.
After adjustment for age, sex, treatment allocation, disease duration, and geographic region, people who were obese (BMI ≥30 kg/m2) at baseline had a significantly lower likelihood of achieving remission at month 13 than those with BMI in the normal range (18.5–24.9 kg/m2), with an odds ratio (OR) of 0.33.
Moreover, intensive treatment was associated with a significantly higher probability of remission than standard care in patients with BMI in the normal range and those who were overweight (BMI 25.0–29.9 kg/m2), but not in those with obesity and a BMI of at least 35 kg/m2, at rates of approximately 40% versus 23%, 42% versus 20%, and 14% versus 11%, respectively.
These results show that “the impact of being overweight was minimal,” whereas “being obese, in particular, having a BMI >35 kg/m2 was most clearly associated with a lack of remission,” say Lee and team in Arthritis Research & Therapy.
In addition, they found that people with obesity at baseline were significantly less likely to achieve an improvement in fatigue (≥10-point improvement on a 100 mm VAS) at month 12 than those with a BMI in the normal range (adjusted OR=0.53).
The researchers also evaluated the impact of baseline depression, anxiety, and illness perception on RA outcomes, finding that these factors were not significant predictors of remission or fatigue at 12 months in the adjusted analysis.
However, they say that having moderate or severe depression at 0, 6, and 12 months was significantly associated with average fatigue scores at these timepoints, while severe anxiety was associated with pain, and illness belief scores were associated with both pain and fatigue.
Taken together, these findings suggest that “[i]ntensive treatment strategies need to account for baseline obesity, psychological status and illness perceptions,” conclude Lee et al.
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