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Arthritis Research and Therapy

, 14:R115

First Online: 14 May 2012Received: 06 February 2012Accepted: 14 May 2012


IntroductionThe 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.

MethodsIn 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.

ResultsMultivariate 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.

ConclusionsThis 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.

AbbreviationsASankylosing spondylitis

BASDAIBath Ankylosing Spondylitis Disease Activity Index

BMIbody mass index

CRPC-reactive protein

HLAhuman leukocyte antigen


NSAIDsnonsteroidal antiinflammatory drugs

RArheumatoid arthritis

TNFtumor necrosis factor

VASvisual analogue scale

Vdvolume of distribution

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-ar3841 contains supplementary material, which is available to authorized users.

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Autor: Sébastien Ottaviani - Yannick Allanore - Florence Tubach - Marine Forien - Anaïs Gardette - Blandine Pasquet - Elisabeth 


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