Impact of obesity on drug retention
| Author, year | Study design, duration | Biologic | Total (n) | Obese (n) | Retention rates |
|---|---|---|---|---|---|
| TNFi | |||||
| Bergstra et al. [67], 2020 | International register, follow up censored at 5000 days | Any TNFi | 5,232 (4,116 BMI data) | 734 | Underweight and overweight patients discontinued TNFi treatment earlier than normal-weight patients. Adjusted(Adj) HR underweight: 1.3 (95% CI 1.07, 1.58); Adj HR BMI 35–39.9: 1.28 (95% CI 1.06, 1.54); Adj HR BMI > 40: 1.67 (95% CI 1.29, 2.18). |
| Elalouf et al. [68], 2021 | Registry, maximum follow-up 5 years | ETN, IFX, ADA, GLM | 521 | 223 | BMI is inversely associated with drug survival. BMI > 40 is more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67–3.10). |
| McCulley et al. [18] 2019 | Retrospective cohort | TNFi | 46,970 | 19,216 | Patients with normal BMI are more likely to discontinue treatment in fully adjusted model HR 1.14 (95% CI 1.07, 1.22) vs. overweight. |
| Other modes of action | |||||
| Alten et al. [70], 2017 | Observational bio-naive biologic failure, 12-month interim analysis | ABA | 674 (biologic naive); 1676 (biologic failure) | 155 (biologic naive); 405 (biologic failure) | No significant impact of BMI regardless of antibody status, or biological naive/exposed. |
| Iannone et al. [54], 2017 | Pooled analysis of European registries, variable duration | ABA | 2,015 | 380 | No impact of obesity on drug retention; HR 1.08 (95% CI 0.89–1.30). |
| Hilliquin et al. [71], 2021 | Prospective cohort, 12 months | TCZ | 291 | 57 | No difference in retention rates at 12 months in non-obese vs. obese 65.32% vs. 58.85%. |
| Mixed biologics | |||||
| Iannone et al. [62], 2015 | Retrospective review, up to 11 years | CTZ, ETN, IFX, GLM, ABA, RTX | 292 | 66 | 1st TNFi: no significant difference in drug survival between obese/non-obese;2nd TNFi: drug survival is lower in obese, patients vs. normal 43.5% vs. 80%. |
| Rashid et al. [69], 2016 | Retrospective cohort, 6 years | Any bDMARD | 2,171 | 799 | Obesity predictor of need to switch bDMARD; OR 1.51 (95% CI 1.04–2.19). |
ABA: abatacept; ADA: adalimumab; Adj; adjusted; bDMARD: biologic disease modifying antirheumatic drug; BMI: body mass index; CI: confidence interval; CTZ: certolizumab; ETN: etanercept; GLM: golimumab; HR: hazard ratio; IFX: infliximab; OR: odds ratio; RR: risk ratio; RTX: rituximab; SDAI: simplified disease activity index; TCZ: tocilizumab; TNFi: tumour necrosis factor-alpha inhibitor