Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis

Caroline B. McCulley, Jennifer Barton, Grant W. Cannon, Brian C. Sauer, Chia Chen Teng, Michael D. George, Liron Caplan, Bryant R. England, Ted R. Mikuls, Joshua F. Baker

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Obese patients with rheumatoid arthritis (RA) may be more likely to discontinue therapy than non-obese patients, possibly signifying a more refractory phenotype. The purpose of this study was to examine the association between body mass index (BMI) and discontinuation rates for different RA treatments accounting for confounding factors. METHODS: Veterans Affairs administrative databases were used to define initial courses of methotrexate (MTX), hydroxychloroquine, sulfasalazine, prednisone, and self-injectable tumour necrosis factor inhibitors (TNFi). Discontinuation was defined as a lapse in drug refill >90 days. Using overweight BMI (25-30 kg/m2) as the referent group, multivariable Cox proportional hazards models were used to evaluate associations between BMI category and time to treatment discontinuation. RESULTS: There were 46,970 initial RA treatment courses identified from 2005-2014 among 23,669 Veterans with RA. In multivariable models, severe obesity (BMI >35 kg/m2), compared to overweight BMI, was not associated with treatment discontinuation with the exception of prednisone [HR 1.10 (1.04, 1.17) p<0.001]. Patients with low (<20 kg/m2) and normal BMI (20-25 kg/m2) were more likely to discontinue MTX, TNFi, and HCQ compared to overweight patients. Other factors associated with earlier MTX and/or TNFi discontinuation included female sex, black race, greater comorbidity, depression, malignancy, congestive heart failure, current smoking, and more recent calendar year. CONCLUSIONS: Obesity was not associated with therapy discontinuation among veterans with RA after accounting for confounding factors, suggesting that obesity is not a biological mediator of more refractory disease. Conversely, low BMI, comorbidity, and depression were identified as important predictors of drug discontinuation.

Original languageEnglish (US)
Pages (from-to)422-428
Number of pages7
JournalClinical and experimental rheumatology
Volume37
Issue number3
StatePublished - May 1 2019

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Antirheumatic Agents
Rheumatoid Arthritis
Body Mass Index
Veterans
Methotrexate
Tumor Necrosis Factor-alpha
Prednisone
Comorbidity
Therapeutics
Obesity
Depression
Hydroxychloroquine
Sulfasalazine
Morbid Obesity
Proportional Hazards Models
Pharmaceutical Preparations
Heart Failure
Smoking
Databases
Phenotype

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

McCulley, C. B., Barton, J., Cannon, G. W., Sauer, B. C., Teng, C. C., George, M. D., ... Baker, J. F. (2019). Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis. Clinical and experimental rheumatology, 37(3), 422-428.

Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis. / McCulley, Caroline B.; Barton, Jennifer; Cannon, Grant W.; Sauer, Brian C.; Teng, Chia Chen; George, Michael D.; Caplan, Liron; England, Bryant R.; Mikuls, Ted R.; Baker, Joshua F.

In: Clinical and experimental rheumatology, Vol. 37, No. 3, 01.05.2019, p. 422-428.

Research output: Contribution to journalArticle

McCulley, CB, Barton, J, Cannon, GW, Sauer, BC, Teng, CC, George, MD, Caplan, L, England, BR, Mikuls, TR & Baker, JF 2019, 'Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis', Clinical and experimental rheumatology, vol. 37, no. 3, pp. 422-428.
McCulley, Caroline B. ; Barton, Jennifer ; Cannon, Grant W. ; Sauer, Brian C. ; Teng, Chia Chen ; George, Michael D. ; Caplan, Liron ; England, Bryant R. ; Mikuls, Ted R. ; Baker, Joshua F. / Body mass index and persistence of conventional DMARDs and TNF inhibitors in rheumatoid arthritis. In: Clinical and experimental rheumatology. 2019 ; Vol. 37, No. 3. pp. 422-428.
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abstract = "OBJECTIVES: Obese patients with rheumatoid arthritis (RA) may be more likely to discontinue therapy than non-obese patients, possibly signifying a more refractory phenotype. The purpose of this study was to examine the association between body mass index (BMI) and discontinuation rates for different RA treatments accounting for confounding factors. METHODS: Veterans Affairs administrative databases were used to define initial courses of methotrexate (MTX), hydroxychloroquine, sulfasalazine, prednisone, and self-injectable tumour necrosis factor inhibitors (TNFi). Discontinuation was defined as a lapse in drug refill >90 days. Using overweight BMI (25-30 kg/m2) as the referent group, multivariable Cox proportional hazards models were used to evaluate associations between BMI category and time to treatment discontinuation. RESULTS: There were 46,970 initial RA treatment courses identified from 2005-2014 among 23,669 Veterans with RA. In multivariable models, severe obesity (BMI >35 kg/m2), compared to overweight BMI, was not associated with treatment discontinuation with the exception of prednisone [HR 1.10 (1.04, 1.17) p<0.001]. Patients with low (<20 kg/m2) and normal BMI (20-25 kg/m2) were more likely to discontinue MTX, TNFi, and HCQ compared to overweight patients. Other factors associated with earlier MTX and/or TNFi discontinuation included female sex, black race, greater comorbidity, depression, malignancy, congestive heart failure, current smoking, and more recent calendar year. CONCLUSIONS: Obesity was not associated with therapy discontinuation among veterans with RA after accounting for confounding factors, suggesting that obesity is not a biological mediator of more refractory disease. Conversely, low BMI, comorbidity, and depression were identified as important predictors of drug discontinuation.",
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AU - George, Michael D.

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