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Arthritis Res Ther. 2012; 14(3): R115.
Published online May 14, 2012. doi:  10.1186/ar3841
PMCID: PMC3446492
Body mass index influences the response to infliximab in ankylosing spondylitis
Sébastien Ottaviani,1 Yannick Allanore,2,3 Florence Tubach,4 Marine Forien,1 Anaïs Gardette,1 Blandine Pasquet,3 Elisabeth Palazzo,1 Marine Meunier,2 Gilles Hayem,1 Chantal Job-Deslandre,2 André Kahan,2 Olivier Meyer,1 and Philippe Dieudé1,5
1Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
2Rheumatology A Department, AP-HP, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
3INSERM U1016, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
4Epidemiology Biostatistics and Clinical Research Department, AP-HP, INSERM, CIE801, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
5INSERM U699, Paris Diderot, Sorbonne Paris Cité University, Faculté de Médecine Xavier Bichat, 16 rue Henri Huchard, Paris, 75018, France
Sébastien Ottaviani: sebastien.ottaviani/at/bch.aphp.fr; Yannick Allanore: yannick.allanore/at/cch.aphp.fr; Florence Tubach: florence.tubach/at/bch.aphp.fr; Marine Forien: marineforien/at/yahoo.fr; Anaïs Gardette: anais_gardette/at/hotmail.fr; Blandine Pasquet: blandine.pasquet/at/bch.aphp.fr; Elisabeth Palazzo: elisabeth.palazzo/at/bch.aphp.fr; Marine Meunier: marine.meunier/at/cch.aphp.fr; Gilles Hayem: gilles.hayem/at/bch.aphp.fr; Chantal Job-Deslandre: chantal.job-deslandre/at/cch.aphp.fr; André Kahan: andre.kahan/at/cch.aphp.fr; Olivier Meyer: olivier.meyer/at/bch.aphp.fr; Philippe Dieudé: philippe.dieude/at/bch.aphp.fr
Received February 6, 2012; Accepted May 14, 2012.
Abstract
Introduction
The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetic consequences. The aim of this study was to determine whether body mass index (BMI) affects response to infliximab (IFX) in ankylosing spondylitis (AS) patients.
Methods
In 155 patients retrospectively included with active AS, the BMI was calculated before initiation of IFX treatment (5 mg/kg intravenously). After 6 months of treatment, changes from baseline in BASDAI, Visual Analogue Scale (VAS) pain, C-reactive protein (CRP) level, and total dose of nonsteroidal antiinflammatory drug (NSAID) were dichotomized with a threshold corresponding to a decrease of 50% of initial level of the measure, into binary variables assessing response to IFX (BASDAI50, VAS50, CRP50, NSAID50). Whether the BMI was predictive of the response to IFX therapy according to these definitions was assessed with logistic regression.
Results
Multivariate analysis found that a higher BMI was associated with a lower response for BASDAI50 (P = 0.0003; OR, 0.87; 95% CI (0.81 to 0.94)), VAS50 (P < 0.0001; OR, 0.87; 95% CI (0.80 to 0.93)); CRP50 (P = 0.0279; OR, 0.93; 95% CI (0.88 to 0.99)), and NSAID50 (P = 0.0077; OR, 0.91; 95% CI (0.85 to 0.97)), criteria. According to the three WHO BMI categories, similar results were found for BASDAI50 (77.6%, 48.9%, and 26.5%; P < 0.0001), VAS50 (72.6%, 40.4%, and 16.7%; P < 0.0001); CRP50 (87.5%, 65.7%, and 38.5%; P = 0.0001), and NSAID50 (63.2%, 51.5%, and 34.6%; P = 0.06).
Conclusions
This study provides the first evidence that a high BMI negatively influences the response to IFX in AS. Further prospective studies, including assessment of the fat mass, pharmacokinetics, and adipokines dosages are mandatory to elucidate the role of obesity in AS IFX response.
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