Concurrent TNFi, DMARD Therapy May Benefit Overweight Patients With Axial Spondyloarthritis

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person on scale
The use of csDMARDs with TNFi may increase the likelihood of achieving clinical response in overweight or obese patients with axial spondyloarthritis.

The concomitant use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and tumor necrosis factor inhibitor (TNFi) therapy was associated with positive clinical response in overweight or obese patients with axial spondyloarthritis (axSpA), according to results from a study published in Arthritis Research & Therapy.

Researchers conducted a prospective observational study of 180 patients with axSpA who were treated with conventional doses of adalimumab or infliximab. Study participants were stratified according to body mass index, which included patients who were overweight or obese (n=102) and of normal weight (n=78). Clinical response to TNFi therapy was assessed after 1 year of treatment using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The association between concurrent csDMARD and TNFi therapy with clinical response was analyzed using multivariable logistic regression.

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After statistical analysis, the researchers found that 44% of patients in the study received concurrent csDMARD and TNFi therapy. Among these participants, the use of concomitant therapy was associated with a positive clinical response (odds ratio [OR], 7.86; 95% CI, 2.39-25.78) and remission (OR, 4.84; 95% CI, 1.09-21.36) in overweight or obese patients.

In contrast, the same association was not seen in normal-weight patients (OR, 1.10; 95% CI, 0.33-3.58).

“Our study suggests that the use of concomitant csDMARDs with TNFi would not be justified in [patients with axSpA] with normal weight as it would not increase the probability of achieving clinical response,” the researchers wrote.

“Further research studies including larger cohorts of patients need to be done to confirm [the results],” they concluded.


Hernandez-Breijo B, Plasencia-Rodriguez C, Navarro-Compan V, et al. Association between concomitant csDMARDs and clinical response to TNF inhibitors in overweight patients with axial spondyloarthritis. Arthritis Res Ther. 2019;21(1):66.