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EULAR 2020 – Speaker interview: Assessing the effect of increased body mass index to TNF inhibitors

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Speaker interview with Dr Mrinalini Dey

Hi welcome to eula tv today i am pleasure to introduce you dr marinelli niday susana academic clinical fellow at the university of liverpool and during the next minute we’ll be talking about her work on assessing the effects of increased body mass index on the response to tnf inhibitors in patients with established rheumatoid arthritis this is the result from the

Meteor database so dr day can you please give a brief overview of this study and what you found yes thank you sebastian and so yes i’m an academic clinical fellow and this is some work which i have done as part of that role um in collaboration with professor landovae in amsterdam so um just a bit of background so high body mass index is increasingly prevalent

Among patients with rheumatoid arthritis so in 2016 the world health organization estimated that approximately 40 of the world’s population is either overweight or obese and when you look at the population with rheumatoid arthritis this actually increases to 60 percent um rheumatoid arthritis um new presentations it’s increasingly prevalent that um obesity is

Um is present at the first presentation of rheumatoid arthritis um and previous studies suggest that high bmi at diagnosis is associated with factors such as um decreased um decreased uh quality of life um and lower um chance of achieving remission um however it’s not clear whether um bmi influences the response to medications such as tnf inhibitors um all to

The same um extent so the aim of our study was to explore whether bmi is associated with response to tnf inhibitors particularly looking at patients newly starting on these drugs and also looking at each drug in turn and in groups such as the mab tnf inhibitors um and we conducted the study in a large international cohort of rheumatoid arthritis patients with

Established disease and our results showed that obesity is associated with a um decreased significantly decreased response to the mab tnf inhibitors um in particular and we feel that this may be relevant going forward particularly um if we which use a personalized medicine approach to treating these patients and it would prove quite a simple and cost-effective

Way of doing this all right those are very interesting results and um can you please tell us a little bit more about the meteor database sure so the um the meteor database is a large international um database capturing real world of daily clinical practice um in the management of patients with rheumatoid arthritis and a meteor itself actually stands for

Measurement of efficacy in the treatment in the era of outcomes of rheumatology um as of 2016 the database had captured um data from more than 39 000 patients um for over 200 000 visits in 32 different countries and of course that continues to grow um and the kind of data that they’re capturing includes medication use disease activity um and components of for

Example physical function and that is at baseline visits and subsequent follow-up visits as well all right and um another thing i would like to know and i would like you to explain that a little bit more is can you describe a little bit more about the core included in this study sure um so so as i’ve said we were using a cohort from the the meteor international

Database um so we included patients who had established rheumatoid arthritis into this study who’d been recruited to the database between 2008 and 2013. um the cohort that we used in this study had 731 patients from 11 countries um in total um that may seem like a small number compared to the size of the database but we have to remember that um real world data

Has many strengths but one of the key limitations is that there may be disparities in comparability and consistency across practices um and so we had to ensure that all of the data we were using was um comparable um at a level at which we were studying um the data which we used 82 percent of patients were female with um a mean age of approximately 56 years

When we looked um at stratifications by bmi um about 36 percent of patients um were of normal bmi another 36 were overweight about 25 were um obese and the remaining um members of the cohort were classed as underweight and due to the low numbers of underweight patients we actually exclude them from the from the analyses and we then looked at the number of

Patients who were on various drugs so um 264 patients were newly started on a biologic drug at their baseline visit and with 254 taking it after after six months um and when you include the patients who were already on any biologic treatment at the start of the study this came to around 400 patients and so that’s really um what the cohort looked like that

We were we were studying um we then stratified the patients based on you know the type of drug they’d been started on and specifically we looked at people who’d been started on um obviously tnf inhibitors so um adalimumab infliximab etanercept and also um galimumab and then we looked at the people who were on map tnf inhibitors separately as well all right so

So far we’ve been um commenting on results um based on tnfi tnf inhibitors used but what about conventional synthetic demons other are there any information around that sure so actually we um we looked at this in a previous study which was um the results were presented at the um british society for rheumatology virtual conference this year um and crucially we

Found that obese patients with um established rheumatoid arthritis again um were significantly less likely to achieve both das 28 remission and a good eula response um compared to those of normal bmi and when treated with conventional synthetic demards and and when we looked at this further um we found that combination combination conventional synthetic demar

Therapy in the overweight and obese populations um was more likely to um achieve more favorable outcomes than monotherapy and when we looked at methotrexate in particular um we found that obese individuals of any disease stage were more likely to be on a higher dose of methotrexate compared to those of normal weight um so again quite striking results in

The in the population taking um csd mods well um certainly these this uh information that you were providing uh will will have a we can have an an impact in clinical practice and uh but can you for to wrap up can you please um comment briefly on what are the main implications that your findings uh will have in clinical practice sure so um i think we’re moving

More towards a we’re trying to move towards a more personalized medicine approach in our patients and i think this is really important because no two patients with rheumatoid arthritis are the same um and what we’ve shown is is that looking at someone’s you know body mass index may be um a simple and cost-effective approach to um to providing um personalized

Medicine um and tailoring you know their dmr treatment in this way um may lead to more favorable outcomes in this group um but i think um these results on a background of what we already know about um body mass index in them in in rheumatoid arthritis um it also you know impresses the impresses the importance of um managing um lifestyle and body mass index

In these patients as well to to achieve better outcomes um overall um the non-pharmacological management of the disease uh yes exactly exactly yeah well uh dr dave those were very interesting results you you have commented on and uh i believe that in the years to come there will be a lot more studies and a lot more evidence regarding the effects of body mass

Index and and also other other forms so to measure to measure for instance uh body fats and other other approaches to measure this um the the weight of the patients and its effects on the on the uh on the treatment on the outcomes of rheumatoid arthritis and and other rheumatic diseases i believe we’ll see a lot of a lot more studies in the years to come so

Uh thank you for your time and uh we hope you enjoyed this interview and keep keep watching us at yola tv

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EULAR 2020 – Speaker interview: Assessing the effect of increased body mass index to TNF inhibitors By EULAR