Table Info

Table 2.

Influence of obesity on response to biologic treatment

Author, year	Study design, duration	Biologic	Total (n)	Obese (n)	Bias & risk of imprecision	Response to treatment/Achievement of remission
TNFi
Baganz et al. [43], 2019	Observational, 3 years	TNFi not specified	388	92	Low	No influence on achieving remission within 6 months of starting first TNFi OR 0.67 (95% CI 0.45–1.70).
Baker et al. [44], 2011	RCT, 52 weeks	GLM	499	127	Low	Higher BMI is independently associated with less joint damage progression.
Bykerk et al. [45], 2021	Pooled RCT data, variable duration	CTZ	8,747	1,180	Low	Increased risk of serious infections and major cardiovascular events, if BMI > 35.
George et al. [13], 2017	Pooled data from 2 RCT, 6 months	GLM	470	103	Low	Lower rates of DAS28 remission in obese patients 17% vs. normal weight 28%. OR remission 0.47 (95% CI 0.24–0.92).
Gremese et al. [46], 2013	Registry, 12 months	ETN, IFX, ADA	575	66	Low	Lower rates of DAS28 remission in obese patients 15.2% vs. non-obese 32%, OR not remission 2.63 (95% CI 1.31–5.26).
Hamann et al. [47], 2019	Observational	CTZ, ETN, IFX, ADA	14,436	NR	Low	Increasing BMI associated with reduced likelihood of sustained remission, OR 0.98 (95% CI 0.97, 0.99) per kg/m² increase.
Klaasen et al. [15], 2011	Prospective cohort, 16 weeks	IFX	89	15	Low, risk of imprecision	BMI higher in EULAR non-responders vs. responders.
Law-Wan et al. [48], 2021	Pooled analysis of 29 RCTs	ADA, ETN, CTZ, GLM, IFX	14,838	NR	Low	Higher rates of EULAR non-response rate were observed in obese patients, OR 0.52 (95% CI 0.43, 0.63) vs. 0.36 (95% CI 0.30, 0.45) for non-obese.
Levitsky et al. [24], 2017	Sub-analysis of RCT, 24 months, treatment-naive	DMARDs or TNFi	403	43	Low	Non-obese patients were more likely to reach remission. Non obese OR 4.6 (95% CI 2.0–10.5) vs. obese OR 3.3 (95% CI 1.4, 8.2). Obesity independent predictor of non-remission at 24 months (adjusted OR 5.2; 95% CI 1.8 to 15.2).
Ottaviani et al. [16], 2015	Retrospective cohort, 6 months	IFX	76	22	Low, risk of imprecision	BMI was significantly lower in patients with EULAR good response, adjusted multivariable analysis OR 0.87 (95% CI 0.76, 0.99), no significant difference for remission.
Reams et al. [49], 2020	Retrospective cohort	2nd TNFi	322	133	Low	Similar response rates to 2nd TNFi across BMI categories.
Sapundzhieva et al. [50], 2019	Observational, 6 months	IFX	30	19	Low, risk of imprecision	Higher DAS28 at 6 months in obese vs. normal BMI 3.89 ± 1.18 vs. 2.50 ± 0.62. Higher rates of DAS28 remission in normal weight vs. overweight or obese 60% vs. 33% vs. 0%.
Other modes of action
D’Agostino et al. [51], 2017	Post hoc analysis of RCT, 6 months	ABA	1,457	433	Low	No impact of obesity on DAS28, SDAI, or CDAI remission. Lower fall in CRP in the obese group. No difference in remission rates between IV or SC routes.
Di Carlo et al. [52], 2019	Post hoc analysis of prospective cohort, 6 months	ABA	130	NR	Low, small numbers, risk of imprecision	No difference in mean BMI between responders and non-responders (DAS28-ESR remission and/or Boolean remission).
Gardette et al. [53], 2016	Retrospective6 months	ABA	141	39	Low	No difference in mean BMI between EULAR responders or those achieving remission.
Iannone et al. [54], 2017	Pooled analysis of European registries, variable duration	ABA	2,015	380	Low	Moderate or good EULAR response rates at 6 months are similar across. BMI categories 39.8% normal BMI, and 40.0% obese.
Mariette et al. [35], 2017	Observational, 6 months analysis	ABA	672	155	Low	No significant difference in EULAR response at 6 months with the obese BMI subgroup.
Ottaviani et al. [55], 2015	Retrospective cohort, 6 months	RTX	114	35	Low	No association between BMI and response to RTX in adjusted multivariable analysis.
Abuhelwa et al. [56], 2020	Pooled data of several RCT	TCZ	5,502	1,654	Low	Obesity associated with less frequent remission by SDAI HR 0.80 (95% CI 0.70–0.92) and CDAI HR 0.77 (95% CI 0.68–0.87).
Arad and Elkayam [57], 2019	Open-label, 24 weeks	TCZ	100	30	Low, risk of imprecision	Inverse association between change in CDAI and BMI between weeks 1 and 12. No association between BMI and achieving remission or LDA at 24 weeks.
Gardette et al. [58], 2016	Retrospective, 6 months	TCZ	115	25	Low, risk of imprecision	No influence of BMI on EULAR moderate or good response or remission.
Huang et al. [39], 2019	Prospective cohort	TCZ	52	6	Low, high risk of imprecision	No difference in mean BMI between DAS28 responders and non-responders or CDAI LDA or remission or DAS28 LDA or remission.
Inanc et al. [38], 2023	Retrospective cohort	TCZ	124	38	Low	No difference in response between obese and non-obese.
Pappas et al. [59], 2020	Registry, 6 months	TCZ	805	356	Low	No difference in mean change in CDAI between obese/non-obese.
Pers et al. [60], 2015	Retrospective cohort, 6 months	TCZ	222	32	Low	No effect of BMI on EULAR response or remission.
Mixed bDMARDs
Baker et al. [61], 2022	Register, response analysed after 3 months	TNFi, non-TNF biologic	5,901	1,299	Low	Reduced MCID response in obese patients. OR 0.88 (95% CI 0.72, 1.08) TNFi. OR 0.82 (95% CI 0.67, 1.01) non TNFi bDMARD. Less likely to achieve CDAI LDA if obese OR 0.85 (95% 0.74, 0.99).
Hirai et al. [37], 2020	Retrospective notes review	IFX, TCZ, and ABA	324	33	Low	BMI ≥ 25 is associated with a lack of efficacy. OR 4.22 (95% CI 1.69–10.5).
Iannone et al. [62], 2015	Retrospective review, up to 11 years	CTZ, ETN, IFX, GLM, ABA, RTX	292	66	Low	1st TNFi: Lower rates of good EULAR response in obese vs. normal 42% vs. 68%; Lower rates of DAS28 remission in obese vs. normal 17% vs. 38%. 2nd TNFi: Lower rates of good EULAR response in obese vs. normal 33% vs. 57%; Lower rates of DAS28 remission in obese vs. normal 12.5% vs. 46%. RTX: Lower rates of good EULAR response in obese vs. normal 27% vs. 67%; Lower rates of DAS28 remission in obese vs. normal 7% vs. 33%.
Kearsley-Fleet et al. [63], 2018	Registry, 20 years	TNFi, non TNFi bDMARD	13,502	NR	Low	bDMARD refractory disease independently associated with obesity, HR 1.2 (95% CI 1.0–1.4).
Kim et al. [36], 2016	Observational, 24 weeks	ABA, TCZ, ETN, ADA	68	13	Low, risk of imprecision	No relationship between BMI with EULAR response or DAS28 remission.
Novella-Navarro et al. [64], 2022	Prospective cohort, 6 months	TCZ, TNFi	105	NR	Low, risk of imprecision	The higher mean BMI in patients who did not attain CDAI LDA or remission was 28.7 ± 5.1 vs. 24.5 ± 4.6 with TNFi. No difference in mean BMI between responders and non-responders to TCZ.
Schafer et al. [65], 2020	Observational, 10.3 years	ADA, TCZ, ETN, ABA, CTZ, GLM, RTX	10,593	2,910	Low	Less likely to attain EULAR response or remission with TNFi in females only. Good response 0.83 (95% CI 0.72, 0.95). Remission RR 0.73 (95% CI 0.61, 0.88). No relationship seen in men, or for ABA, RTX, and TCZ.
Vallejo-Yagüe et al. [66], 2021	Registry	TNFi, non TNF bDMARD, tsDMARD	3,217	546	Low	Higher DAS28 in obese patients.

ABA: abatacept; ADA: adalimumab; bDMARD: biologic disease-modifying antirheumatic drug; BMI: body mass index; CDAI: clinical disease activity index; CI: confidence interval; CTZ: certolizumab; DAS28: disease activity score 28 joints; ETN: etanercept; GLM: golimumab; HR: hazard ratio; IFX: infliximab; LDA: low disease activity; NR: not reported; OR: odds ratio; RR: risk ratio; RTX: rituximab; SDAI: simplified disease activity index; TCZ: tocilizumab; TNFi: tumour necrosis factor alpha inhibitor; tsDMARD: targeted systemic disease-modifying antirheumatic drug; RCT: randomised controlled trial; EULAR: European Alliance of Associations for Rheumatology; IV: intravenous; SC: subcutaneous; ESR: erythrocyte sedimentation rate; MCID: minimal clinically important difference

Declarations

Acknowledgments

The authors acknowledge support from Keri Bramford-Hale for advice and assistance with database searches (CEBIS). We also thank Dr Toby Cox for reviewing the readability of the final version of the manuscript.

Author contributions

ZI: Conceptualization, Formal analysis, Writing—original draft, Writing—review & editing. NJG: Conceptualization, Formal analysis, Supervision, Writing—original draft, Writing—review & editing.

Conflicts of interest

The authors declare that they have no relevant conflicts of interest for this work.

Ethical approval

The service evaluation was reviewed and registered by the University Hospitals Coventry & Warwickshire NHS Trust Research & Development Department. Ethical approval was not required (Ref SE0353).

Consent to participate

Informed consent was not required for this analysis of routinely collected clinical data.

Consent to publication

Not applicable.

Availability of data and materials

Data sharing is not permitted within local approvals, but authors are willing to respond to readers’ reasonable questions.

Funding

ZI is supported by a National Institute for Health Research (NIHR) Academic Clinical Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright

References

Poudel D, George MD, Baker JF. The impact of obesity on disease activity and treatment response in rheumatoid arthritis. Curr Rheumatol Rep. 2020;22:56. [DOI] [PubMed] [PMC]

Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Kitas GD. Obesity in rheumatoid arthritis. Rheumatology. 2011;50:450–62. [DOI] [PubMed]

George MD, Giles JT, Katz PP, England BR, Mikuls TR, Michaud K, et al. Impact of obesity and adiposity on inflammatory markers in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2017;69:1789–98. [DOI] [PubMed] [PMC]

Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282:2131–5. [DOI] [PubMed]

Albrecht K, Richter A, Callhoff J, Huscher D, Schett G, Strangfeld A, et al. Body mass index distribution in rheumatoid arthritis: a collaborative analysis from three large German rheumatoid arthritis databases. Arthritis Res Ther. 2016;18:149. [DOI] [PubMed] [PMC]

Maglio C, Peltonen M, Rudin A, Carlsson LM. Bariatric surgery and the incidence of psoriasis and psoriatic arthritis in the Swedish obese subjects study. Obesity (Silver Spring). 2017;25:2068–73. [DOI] [PubMed] [PMC]

Baker JF, England BR, Mikuls TR, Sayles H, Cannon GW, Sauer BC, et al. Obesity, weight loss, and progression of disability in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018;70:1740–7. [DOI] [PubMed] [PMC]

Nikiphorou E, Norton S, Young A, Dixey J, Walsh D, Helliwell H, et al.; Early Rheumatoid Arthritis Study and the Early Rheumatoid Arthritis Network. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network UK prospective cohorts. Rheumatology. 2018;57:1194–202. [DOI] [PubMed]

Bigal ME, Lipton RB, Holland PR, Goadsby PJ. Obesity, migraine, and chronic migraine: possible mechanisms of interaction. Neurology. 2007;68:1851–61. [DOI] [PubMed]

10.

Bauer EM, Ben-Artzi A, Duffy EL, Elashoff DA, Vangala SS, Fitzgerald J, et al. Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients. BMC Musculoskelet Disord. 2017;18:99. [DOI] [PubMed] [PMC]

11.

Goossens J, Coustet B, Palazzo E, Dieudé P, Ottaviani S. Overweight and obesity affect clinical assessment of synovitis in rheumatoid arthritis: comparison of ultrasonography and clinical exam. Clin Exp Rheumatol. 2019;37:49–54. [PubMed]

12.

Baker JF, Østergaard M, George M, Shults J, Emery P, Baker DG, et al. Greater body mass independently predicts less radiographic progression on X-ray and MRI over 1–2 years. Ann Rheum Dis. 2014;73:1923–8. [DOI] [PubMed] [PMC]

13.

George MD, Østergaard M, Conaghan PG, Emery P, Baker DG, Baker JF. Obesity and rates of clinical remission and low MRI inflammation in rheumatoid arthritis. Ann Rheum Dis. 2017;76:1743–6. [DOI] [PubMed]

14.

Mangnus L, Nieuwenhuis WP, van Steenbergen HW, Huizinga TW, Reijnierse M, van der Helm-van Mil A. Body mass index and extent of MRI-detected inflammation: opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons. Arthritis Res Ther. 2016;18:245. [DOI] [PubMed] [PMC]

15.

Klaasen R, Wijbrandts CA, Gerlag DM, Tak PP. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum. 2011;63:359–64. [DOI] [PubMed]

16.

Ottaviani S, Gardette A, Tubach F, Roy C, Palazzo E, Gill G, et al. Body mass index and response to infliximab in rheumatoid arthritis. Clin Exp Rheumatol. 2015;33:478–83. [PubMed]

17.

Takahashi C, Kaneko Y, Okano Y, Taguchi H, Oshima H, Izumi K, et al. Association of erythrocyte methotrexate-polyglutamate levels with the efficacy and hepatotoxicity of methotrexate in patients with rheumatoid arthritis: a 76-week prospective study. RMD Open. 2017;3:e000363. [DOI] [PubMed] [PMC]

18.

McCulley CB, Barton JL, Cannon GW, Sauer BC, Teng CC, George MD, et al. Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis. Clin Exp Rheumatol. 2019;37:422–8. [PubMed] [PMC]

19.

Solomon DH, Glynn RJ, Karlson EW, Lu F, Corrigan C, Colls J, et al. Adverse effects of low-dose methotrexate: a randomized trial. Ann Intern Med. 2020;172:369–80. [DOI] [PubMed] [PMC]

20.

Mori S, Arima N, Ito M, Fujiyama S, Kamo Y, Ueki Y. Non-alcoholic steatohepatitis-like pattern in liver biopsy of rheumatoid arthritis patients with persistent transaminitis during low-dose methotrexate treatment. PloS One. 2018;13:e0203084. [DOI] [PubMed] [PMC]

21.

Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care. 2018;41:513–21. [DOI] [PubMed]

22.

Daien CI, Morel J. Predictive factors of response to biological disease modifying antirheumatic drugs: towards personalized medicine. Mediators Inflamm. 2014;2014:386148. [DOI] [PubMed] [PMC]

23.

Shan J, Zhang J. Impact of obesity on the efficacy of different biologic agents in inflammatory diseases: a systematic review and meta-analysis. Joint Bone Spine. 2019;86:173-83. [DOI] [PubMed]

24.

Levitsky A, Brismar K, Hafström I, Hambardzumyan K, Lourdudoss C, van Vollenhoven RF, et al. Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial. RMD Open. 2017;3:e000458. [DOI] [PubMed] [PMC]

25.

Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253. [PubMed]

26.

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81. [DOI] [PubMed]

27.

Wells G, Becker J, Teng J, Dougados M, Schiff M, Smolen J, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis. 2009;68:954–60. [DOI] [PubMed] [PMC]

28.

Stegenga H, Haines A, Jones K, Wilding J; Guideline Development Group. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ. 2014;349:g6608. [DOI] [PubMed]

29.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. [DOI] [PubMed] [PMC]

30.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. [DOI] [PubMed] [PMC]

31.

Data collection form [Internet]. The Cochrane Collaboration; c2024 [cited 2023 Aug 23] Available from: https://training.cochrane.org/sites/training.cochrane.org/files/public/uploads/resources/downloadable_resources/English/Collecting%20data%20-%20form%20for%20RCTs%20only.doc

32.

Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. [DOI] [PubMed]

33.

Higgins JPT, Morgan RL, Rooney AA, Taylor KW, Thayer KA, Silva RA, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int. 2024;186:108602. [DOI] [PubMed]

34.

Mariette X, Schaeverbeke T, Gaudin P, Chartier M, Heitzmann J, Vannier-Moreau V, et al. Two-year abatacept retention rate in clinical practice in the French ACTION cohort. Joint Bone Spine. 2019;86:753–9. [DOI] [PubMed]

35.

Mariette X, Alten R, Nüßlein HG, Galeazzi M, Lorenz HM, Cantagrel A, et al. The effect of body mass index on clinical response to abatacept as a first-line biologic for rheumatoid arthritis: 6-month results from the 2-year, observational, prospective ACTION study. Joint Bone Spine. 2017;84:571–6. [DOI] [PubMed]

36.

Kim SK, Choe JY, Park SH, Lee H. No predictive effect of body mass index on clinical response in patients with rheumatoid arthritis after 24 weeks of biological disease-modifying antirheumatic drugs: a single-center study. Clin Rheumatol. 2016;35:1129–36. [DOI] [PubMed]

37.

Hirai T, Funaki A, Murakami K, Hanada K, Itoh T. Effects of overweight and underweight on the treatment outcomes of rheumatoid arthritis patients treated with biological drugs: a retrospective observational descriptive study. J Clin Pharm Ther. 2020;45:666–73. [DOI] [PubMed]

38.

Inanc GN, Terzioğlu ME, Karabulut Y, Yılmaz Z, Tarhan EF, Enecik ME, et al. A national, multicenter, retrospective study evaluating retention rate and efficacy of tocilizumab treatment in patients with active rheumatoid arthritis who had an inadequate response to csDMARDs and/or TNF inhibitors. Turk J Med Sci. 2023;53:731–43. [DOI] [PubMed] [PMC]

39.

Huang H, Han C, Li Z, Wang TH, Wen Q, Xie BH, et al. Body mass index and clinical response to tocilizumab in patients with rheumatoid arthritis. Arch Rheumatol. 2019;34:406–13. [DOI] [PubMed] [PMC]

40.

Balsa A, Carmona L, González-Alvaro I, Belmonte MA, Tena X, Sanmartí R, et al. Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis. J Rheumatol. 2004;31:40–6. [PubMed]

41.

Aletaha D, Nell VPK, Stamm T, Uffmann M, Pflugbeil S, Machold K, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005;7:R796. [DOI] [PubMed] [PMC]

42.

Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology. 2003;42:244–57. [DOI] [PubMed]

43.

Baganz L, Richter A, Albrecht K, Schneider M, Burmester GR, Zink A, et al. Are prognostic factors adequately selected to guide treatment decisions in patients with rheumatoid arthritis? A collaborative analysis from three observational cohorts. Semin Arthritis Rheum. 2019;48:976–82. [DOI] [PubMed]

44.

Baker JF, George M, Baker DG, Toedter G, Von Feldt JM, Leonard MB. Associations between body mass, radiographic joint damage, adipokines and risk factors for bone loss in rheumatoid arthritis. Rheumatology. 2011;50:2100–7. [DOI] [PubMed]

45.

Bykerk VP, Blauvelt A, Curtis JR, Gaujoux‐Viala C, Kvien TK, Winthrop K, et al. Associations between safety of certolizumab pegol, disease activity, and patient characteristics, including corticosteroid use and body mass index. ACR Open Rheumatol. 2021;3:501–11. [DOI] [PubMed] [PMC]

46.

Gremese E, Carletto A, Padovan M, Atzeni F, Raffeiner B, Giardina A, et al.; Gruppo Italiano di Studio sulle Early Arthritis (GISEA). Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine. Arthritis Care Res (Hoboken). 2013;65:94–100. [DOI] [PubMed]

47.

Hamann PD, Pauling JD, McHugh N, Shaddick G, Hyrich K; BSRBR-RA Contributors Group. Predictors, demographics and frequency of sustained remission and low disease activity in anti-tumour necrosis factor–treated rheumatoid arthritis patients. Rheumatology. 2019;58:2162–9. [DOI] [PubMed] [PMC]

48.

Law-Wan J, Sparfel MA, Derolez S, Azzopardi N, Goupille P, Detert J, et al. Predictors of response to TNF inhibitors in rheumatoid arthritis: an individual patient data pooled analysis of randomised controlled trials. RMD Open. 2021;7:e001882. [DOI] [PubMed] [PMC]

49.

Reams J, Berger A, Denio A. Efficacy predictors of a second tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis. Medicine. 2020;99:e21827. [DOI] [PubMed] [PMC]

50.

Sapundzhieva T, Karalilova R, Batalov A. Body mass index impact on disease activity, clinical and sonographic remission rates in patients with rheumatoid arthritis. Curr Rheumatol Rev. 2019;15:215–23. [DOI] [PubMed]

51.

D’Agostino MA, Alten R, Mysler E, Le Bars M, Ye J, Murthy B, et al. Body mass index and clinical response to intravenous or subcutaneous abatacept in patients with rheumatoid arthritis. Clin Rheumatol. 2017;36:2655–65. [DOI] [PubMed] [PMC]

52.

Di Carlo M, Salaffi F, Gremese E, Iannone F, Lapadula G, Ferraccioli G, et al.; GISEA Study Group. Body mass index as a driver of selection of biologic therapy in rheumatoid arthritis. Results from the US-CLARA study. Eur J Intern Med. 2019;66:57–61. [DOI] [PubMed]

53.

Gardette A, Ottaviani S, Sellam J, Berenbaum F, Lioté F, Fautrel B, et al. Body mass index and response to abatacept in rheumatoid arthritis. Eur J Clin Invest. 2016;46:1048–52. [DOI] [PubMed]

54.

Iannone F, Courvoisier DS, Gottenberg JE, Hernandez MV, Lie E, Canhão H, et al. Body mass does not impact the clinical response to intravenous abatacept in patients with rheumatoid arthritis. Analysis from the “pan-European registry collaboration for abatacept (PANABA). Clin Rheumatol. 2017;36:773–9. [DOI] [PubMed]

55.

Ottaviani S, Gardette A, Roy C, Tubach F, Gill G, Palazzo E, et al. Body mass index and response to rituximab in rheumatoid arthritis. Joint Bone Spine. 2015;82:432–6. [DOI] [PubMed]

56.

Abuhelwa AY, Hopkins AM, Sorich MJ, Proudman S, Foster DJ, Wiese MD. Association between obesity and remission in rheumatoid arthritis patients treated with disease-modifying anti-rheumatic drugs. Sci Rep. 2020;10:18634. [DOI] [PubMed] [PMC]

57.

Arad U, Elkayam O. Association of serum tocilizumab trough concentrations with clinical disease activity index scores in adult patients with rheumatoid arthritis. J Rheumatol. 2019;46:1577–81. [DOI] [PubMed]

58.

Gardette A, Ottaviani S, Sellam J, Berenbaum F, Lioté F, Meyer A, et al. Body mass index and response to tocilizumab in rheumatoid arthritis: a real life study. Clin Rheumatol. 2016;35:857–61. [DOI] [PubMed]

59.

Pappas DA, Etzel CJ, Crabtree M, Blachley T, Best J, Zlotnick S, et al. Effectiveness of Tocilizumab in patients with rheumatoid arthritis is unaffected by comorbidity burden or obesity: data from a US registry. J Rheumatol. 2020;47:1464–74. [DOI] [PubMed]

60.

Pers YM, Godfrin-Valnet M, Lambert J, Fortunet C, Constant E, Mura T, et al. Response to tocilizumab in rheumatoid arthritis is not influenced by the body mass index of the patient. J Rheumatol. 2015;42:580–4. [DOI] [PubMed]

61.

Baker JF, Reed G, Poudel DR, Harrold LR, Kremer JM. Obesity and response to advanced therapies in rheumatoid arthritis. Arthritis Care Res. 2022;74:1909–16. [DOI] [PubMed]

62.

Iannone F, Fanizzi R, Notarnicola A, Scioscia C, Anelli MG, Lapadula G. Obesity reduces the drug survival of second line biological drugs following a first TNF-α inhibitor in rheumatoid arthritis patients. Joint Bone Spine. 2015;82:187–91. [DOI] [PubMed]

63.

Kearsley-Fleet L, Davies R, De Cock D, Watson KD, Lunt M, Buch MH, et al.; BSRBR-RA Contributors Group. Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis. 2018;77:1405–12. [DOI] [PubMed] [PMC]

64.

Novella-Navarro M, Genre F, Hernández-Breijo B, Remuzgo-Martínez S, Martínez-Feito A, Peiteado D, et al. Obesity and response to biological therapy in rheumatoid arthritis: the role of body mass index and adipose tissue cytokines. Clin Exp Rheumatol. 2022;40:1726–32. [DOI] [PubMed]

65.

Schafer M, Meißner Y, Kekow J, Berger S, Remstedt S, Manger B, et al. Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis. Rheumatology. 2020;59:1916–26. [DOI] [PubMed] [PMC]

66.

Vallejo-Yagüe E, Burkard T, Möller B, Finckh A, Burden AM. Comparison of psoriatic arthritis and rheumatoid arthritis patients across body mass index categories in Switzerland. J Clin Med. 2021;10:3194. [DOI] [PubMed] [PMC]

67.

Bergstra SA, Allaart CF, Vega-Morales D, De Buck M, Murphy E, Escoto KS, et al. Body mass index and treatment survival in patients with RA starting treatment with TNFα-inhibitors: long-term follow-up in the real-life METEOR registry. RMD Open. 2020;6:e001203. [DOI] [PubMed] [PMC]

68.

Elalouf O, Lidar M, Reitblat T, Zisman D, Balbir-Gurman A, Hakakian O, et al. High body mass index is associated with shorter retention of tumor necrosis factor-alpha blocker treatment in rheumatoid arthritis. Biologics. 2021;15:279–87. [DOI] [PubMed] [PMC]

69.

Rashid N, Lin AT, Aranda Jr G, Lin KJ, Guerrero VN, Nadkarni A, et al. Rates, factors, reasons, and economic impact associated with switching in rheumatoid arthritis patients newly initiated on biologic disease modifying anti-rheumatic drugs in an integrated healthcare system. J Med Econ. 2016;19:568–75. [DOI] [PubMed]

70.

Alten R, Mariette X, Lorenz HM, Galeazzi M, Cantagrel A, Nüßlein HG, et al. Real-world predictors of 12-month intravenous abatacept retention in patients with rheumatoid arthritis in the ACTION observational study. RMD Open. 2017;3:e000538. [DOI] [PubMed] [PMC]

71.

Hilliquin P, Barnetche T, Baillet A, Flipo RM, Lespessailles E, Roux C, et al. Real-world 1-year retention rate of subcutaneous tocilizumab treatment in patients with moderate to severe active rheumatoid arthritis: TANDEM study. Rheumatol Ther. 2021;8:95–108. [DOI] [PubMed] [PMC]

72.

Naranjo A, Sokka T, Descalzo MA, Calvo-Alén J, Hørslev-Petersen K, Luukkainen RK, et al.; QUEST-RA Group. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther. 2008;10:R30. [DOI] [PubMed] [PMC]

73.

Armstrong DJ, McCausland EM, Quinn AD, Wright GD. Obesity and cardiovascular risk factors in rheumatoid arthritis. Rheumatology. 2006;45:782. [DOI] [PubMed]

74.

Sharma A, Kumar A, Jha A, Agarwal A, Misra A. The impact of obesity on inflammatory markers used in the assessment of disease activity in rheumatoid arthritis–a cross-sectional study. Reumatologica. 2020;58:9–14. [DOI] [PubMed] [PMC]

75.

Janus kinase inhibitors (JAKi)-referral [Internet]. Amsterdam: European Medicine Agency; c1995–2024 [2023 Nov 9]. Available from: https://www.ema.europa.eu/en/medicines/human/referrals/janus-kinase-inhibitors-jaki

76.

Crowson CS, Matteson EL, Davis JM 3rd, Gabriel SE. Contribution of obesity to the rise in incidence of rheumatoid arthritis. Arthritis Care Res. 2013;65:71–7. [DOI] [PubMed] [PMC]

77.

Roodenrijs NMT, van der Goes MC, Welsing PMJ, Tekstra J, Lafeber FPJG, Jacobs JWG, et al. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology. 2020;60:3778–88. [DOI] [PubMed]

78.

Kreps DJ, Halperin F, Desai SP, Zhang ZZ, Losina E, Olson AT, et al. Association of weight loss with improved disease activity in patients with rheumatoid arthritis: a retrospective analysis using electronic medical record data. Int J Clin Rheumtol. 2018;13:1–10. [DOI] [PubMed] [PMC]