Of four disease-modifying antirheumatic drugs for patients with rheumatoid arthritis, leflunomide was most likely to cause weight loss and prednisone was most associated with weight gain, results of a study indicate.
The study, “Changes in Body Mass Related to the Initiation of Disease Modifying Therapies in Rheumatoid Arthritis,” was recently published in the journal Arthritis & Rheumatology.
Low body mass index (BMI) is associated with adverse long-term outcomes in rheumatoid arthritis (RA). Associations between BMI and long-term risks may be partially explained by disease-related weight loss over time among patients with severe rheumatoid arthritis. Disease modifying treatments (DMARDs) used for rheumatoid arthritis might also influence changes in weight.
Joshua F. Baker at the Philadelphia VA Medical Center in Pennsylvania, and colleagues assessed how primary rheumatoid arthritis therapies influence changes in BMI. Using three large administrative databases, the researchers identified 32,859 rheumatoid arthritis patients who received treatment with methotrexate, leflunomide, prednisone and tumor necrosis factor inhibitors (TNFis).
As potential independent factors, the researchers also looked at the patients’ age, sex, race, BMI, seropositivity for anticyclic citrullinated peptides (CCP), diabetes, current smoking, comorbidities, C-reactive protein (CRP) levels, interstitial or other lung disease, malignancies, history of myocardial infarction, chronic kidney disease, and other factors.
The team found that the majority of the patients who were treated with leflunomide were Caucasian, had seropositivity, were treated with concomitant prednisone, and were less likely to receive methotrexate as a treatment option.
Patients who were treated with either prednisone or leflunomide were more likely to have lung disease, have higher levels of CRP, and to have a lower BMI at the study baseline. These patients were also more likely to have chronic heart failure when compared to rheumatoid arthritis patients who were treated with either methotrexate or TNFis. Patients who received TNFi therapy were less likely to have chronic heart failure or malignancies.
The results of the analyses showed that weight gain was seen at six months among users of methotrexate, prednisone, and TNFi. On average, prednisone-treated patients had significantly more weight gain, while leflunomide-treated patients showed a weight loss. Results from the multivariable statistical analyses showed that there was more weight loss among leflunomide users.
An older age, baseline CRP, less improvement in CRP, greater baseline BMI, active smoking, CCP seropositivity, longer disease duration, a history of lung disease, malignancy or chronic heart failure, and greater overall comorbidity were independently associated with a greater risk of weight loss at six months.