Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Oct 17;25(1):202.
doi: 10.1186/s13075-023-03187-4.

High BMI is associated with lower TNF-α inhibitor serum trough levels and higher disease activity in patients with axial spondyloarthritis

Liseth de Wolff  1 , Suzanne Arends  2 , Elisabeth Brouwer  2 , Hendrika Bootsma  2 , Anneke Spoorenberg  2
Affiliations
Observational Study

High BMI is associated with lower TNF-α inhibitor serum trough levels and higher disease activity in patients with axial spondyloarthritis

Liseth de Wolff et al. Arthritis Res Ther. .

Abstract

Background: TNF-α inhibitor (TNFi) serum trough levels have previously been found to be related to disease activity in axial spondyloarthritis (axSpA). However, most research regarding serum trough levels has been conducted in patients who only recently started TNFi therapy. Therefore, our objective was to explore TNFi serum trough level measurements in relation to disease activity and BMI in the total axSpA population in daily clinical practice, also including patients on long-term TNFi therapy.

Methods: Consecutive patients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were approached for a TNFi serum trough level measurement during their regular outpatient visit at the UMCG. Spearman's correlation coefficient was used to analyse the relation of serum trough levels with disease activity and BMI. Logistic regression was performed to analyse the relation between therapeutic drug levels and disease activity, corrected for potential confounders, including BMI.

Results: Thirty-four patients on adalimumab and 21 patients on etanercept were included. Mean age was 45 ± 12 years, 47% were male, median BMI was 26.4 (IQR 23.9-32.5) and median treatment duration was 41 months (range 2-126). According to definitions of Sanquin, 47% of patients had therapeutic serum trough levels. No significant correlations were found between TNFi levels and disease activity (ASDAS-CRP: adalimumab: ρ = -0.16, p = 0.39; etanercept: ρ = -0.29, p = 0.20). TNFi levels were moderately correlated with BMI (adalimumab: ρ = -0.48, p = 0.004; etanercept: ρ = -0.50, p = 0.021). Patients with active disease (ASDAS ≥ 2.1) showed higher BMI than patients with inactive disease (median 29.7 vs. 24.6, p = 0.015). In multivariable regression analyses, BMI was identified as the only confounder for the relationship between therapeutic drug levels and ASDAS.

Conclusion: In this cross-sectional, observational study of axSpA patients mainly on long-term treatment with TNFi, higher BMI was significantly associated with lower adalimumab and etanercept serum trough levels and higher disease activity.

Keywords: Axial spondyloarthritis; BMI; Disease activity; Serum trough levels; TNF-α inhibitors.

PubMed Disclaimer

Conflict of interest statement

L. de Wolff: no financial disclosures.

S. Arends: research grant from Pfizer.

E. Brouwer: no financial disclosures.

H. Bootsma: no financial disclosures.

A. Spoorenberg: grant/research support from Abbvie, Pfizer, UCB, Novartis, consultant for Abbvie, Pfizer, MSD, UCB and Novartis.

Figures

Fig. 1
Fig. 1
Scatterplot of BMI and serum trough level of adalimumab (A) and etanercept (B)
See this image and copyright information in PMC

References

    1. Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2022;82(1):19–34. - PubMed
    1. Arends S, Brouwer E, Efde M, Van der V, Bootsma H, Wink F, et al. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice. Clin Exp Rheumatol. 2017;35(1):61–68. - PubMed
    1. García-Lagunar MH, Gutiérrez-Cívicos MR, García-Simón MS, Conesa-Zamora P, Jimenez-Santos E, Cano-Vivar P, et al. Reasons for discontinuation and adverse effects of TNFα inhibitors in a cohort of patients with rheumatoid arthritis and ankylosing spondylitis. Ann Pharmacother. 2017;51(5):388–393. doi: 10.1177/1060028016682330. - DOI - PubMed
    1. Chen DY, Chen YM, Hung WT, Chen HH, Hsieh CW, Chen YH, et al. Immunogenicity, drug trough levels and therapeutic response in patients with rheumatoid arthritis or ankylosing spondylitis after 24-week golimumab treatment. Ann Rheum Dis. 2015;74(12):2261–4. - PubMed
    1. Kneepkens EL, Krieckaert CLM, Van Der Kleij D, Nurmohamed MT, Van Der Horst-Bruinsma IE, Rispens T, et al. Lower etanercept levels are associated with high disease activity in ankylosing spondylitis patients at 24 weeks of follow-up. Ann Rheum Dis. 2015;74(10):1825–1829. doi: 10.1136/annrheumdis-2014-205213. - DOI - PubMed

Publication types

MeSH terms