Table Info

Table 3.

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

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

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