Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study
Violetta Dubovyk, Georgios K. Vasileiadis, Tahzeeb Fatima, Yuan Zhang, Meliha C Kapetanovic, Alf Kastbom, Milad Rizk, Annika Söderbergh, Sizheng Steven Zhao, Ronald van Vollenhoven, Merete Lund Hetland, Espen A. Haavardsholm, Dan Nordström, Michael T. Nurmohamed, Björn Guðbjörnsson, Jon Lampa, Mikkel Østergaard, Marte Schrumpf Heiberg, Tuulikki Sokka, Gerður Gröndal, Kristina Lend, Kim Hørslev‐Petersen, Till Uhlig, Anna Rudin, Cristina Maglio
Abstract
OBJECTIVE: This report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early rheumatoid arthritis (RA). METHODS: . All participants were randomised 1:1:1:1 to one of four treatment arms: active conventional treatment, certolizumab-pegol, abatacept and tocilizumab. Clinical and laboratory measurements were performed at baseline and at 8, 12, 24 and 48-week follow-up. The primary endpoint for this report was response to treatment based on Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission and Disease Activity Score with 28 joints using C-reactive protein (DAS28-CRP) <2.6 stratified by BMI. RESULTS: Out of 793 people included in the present report, 161 (20%) had obesity at baseline. During follow-up, participants with baseline obesity had higher disease activity compared with those with lower BMI, despite having similar disease activity at baseline. In survival analyses, obesity was associated with a lower likelihood of achieving response to treatment during follow-up for up to 48 weeks (CDAI remission, HR 0.84, 95% CI 0.67 to 1.05; SDAI, HR 0.77, 95% CI 0.62 to 0.97; DAS28-CRP <2.6, HR 0.78, 95% CI 0.64 to 0.95). The effect of obesity on response to treatment was not influenced by the treatment arms. CONCLUSION: In people with untreated early RA followed up for up to 48 weeks, obesity was associated with a lower likelihood of good treatment response, irrespective of the type of randomised treatment received. TRIAL REGISTRATION NUMBER: NCT01491815.