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Rheumatology (Oxford). 2016 Dec;55(12):2191-2199. Epub 2016 Sep 19.

The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries.

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Department of Rheumatology, Gentofte Hospital, Rigshospitalet, Hellerup
Bispebjerg and Frederiksberg Hospital, Parker Institute, Frederiksberg.
Department of Rheumatology, Gentofte Hospital, Rigshospitalet, Hellerup.
DANBIO Registry, Gentofte Hospital, Rigshospitalet, Hellerup.
Landspitali University Hospital, Center for Rheumatology Research (ICEBIO).
Faculty of Medicine, University of Iceland.
Department for Scientific Affairs, Landspitali University Hospital, Reykjavik, Iceland.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.



To investigate the impact of obesity on response to the first TNF-α inhibitor (TNFI) treatment course in patients with PsA followed in routine care.


We performed an observational cohort study based on the Danish and Icelandic biologics registries. Kaplan-Meier plots, Cox and logistic regression analyses were performed to study the impact of obesity (BMI ⩾30 kg/m2) on TNFI adherence and response after 6 months (according to 20/50/70% improvement in ACR criteria and EULAR criteria). Subanalyses studied the impact of obesity according to gender, TNFI type and nationality.


Among 1943 PsA patients (193 Icelandic/1750 Danish) identified in the registries, 1271 (65%) had available BMI and 408 (32%) were obese. The median follow-up-time was 1.5 years [interquartile range (IQR) 0.5-3.9]. Obese patients had higher baseline disease activity, for example, 28-joint DAS [mean 4.6 (sd 1.2) vs 4.4 (1.2)]; CRP [median 9 mg/l (IQR 5-19) vs 7 (3-18)] and visual analogue scale-pain [66 mm (IQR 48-76) vs 60 (38-74)], compared with non-obese patients (all P < 0.05). TNFI adherence was shorter in obese patients, especially among men, where the median TNFI duration was 2.5 years (95% CI 1.7, 3.2) in obese vs 5.9 (4.1, 7.7) in non-obese patients (P < 0.01). A EULAR good or moderate (EGOM) response was achieved by 55% of obese vs 65% of non-obese patients after 6 months (P = 0.02). In multivariable analyses, obesity increased the risk of TNFI withdrawal [hazard ratio 1.6 (95% CI 1.3, 2.0)] and reduced odds for EGOM response [odds ratio 0.47 (95% CI 0.29, 0.72)]. The impact of obesity was significant across genders, TNFI types and nationality.


Obesity was associated with higher disease activity and seemed to diminish response and adherence to TNFIs in PsA.


anti-TNF drugs; obesity; outcome measures; psoriatic arthritis; registry

[Indexed for MEDLINE]

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