Treatment with a tumor necrosis factor inhibitor (TNFi) for 1 year was associated with favorable changes in total lean mass, fat-free mass index, and skeletal muscle mass index as well as improvements in grip strength in patients with rheumatoid arthritis (RA) previously naive to biologic disease-modifying antirheumatic drugs (bDMARDs), according to study findings published in the Journal of Clinical Medicine.

This study included patients with active RA (age, 58.5±10.8 years; 75% women) who were biologically-naive but had started a treatment for their disease. All patients had at least 1 year of follow-up data available after starting therapy. Patients were classified by whether they received a TNFi (n=47), a non-TNFi-targeted biologic agent (n=18), or only a conventional DMARD (cDMARD; n=18).

Total body dual energy X-ray absorptiometry (DXA) scanning was performed at follow-up to evaluate changes in body composition, including changes in lean mass and fat-free mass. The researchers also measured changes in grip strength of the dominant hand.


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The median duration of RA in this population was 3.7 years. In the TNFi group, patients received either etanercept (n=35), adalimumab (n=6), or golimumab (n=1). In the non-TNFi group, patients received rituximab (n=10), abatacept (n=6), and tocilizumab (n=2).

At 1 year following TNFi treatment, the investigators observed significant increases in total lean mass (P =.015), fat-free mass index (P =.013), and skeletal muscle mass index (P =.010). Body composition changes corresponded with an improvement in hand grip strength (P <.001) and walk test at 6 months (P =.006) and 12 months (P <.001).

In contrast to these findings, no significant changes in body composition were noted after 12 months among patients with RA receiving non-TNFI therapy. At 6 months, the participants in this group had an increase in body fat percentage (P =.016), a decrease in visceral fat (P =.024), and a decrease in total lean mass (P =.026). Patients treated with cDMARD alone experienced only a significant increase in visceral fat at 1 year (P =.033).

Limitations of this study included its nonrandomized design as well as the small number of patients in the control and non-TNFi groups.

The study investigators concluded that the findings suggest “a favorable metabolic profile of TNFi” when given to patients with RA.

Disclosure: Some authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Vial G, Lambert C, Pereira B, et al. The effect of TNF and non-TNF-targeted biologics on body composition in rheumatoid arthritis. J Clin Med. 2021;10(3):487. doi:10.3390/jcm10030487