BOSTON — Overweight patients with early rheumatoid arthritis were less likely to achieve remission during treatment with conventional disease-modifying drugs than were those with a normal body mass index.
Overweight and obese patients fared better on a regimen that included infliximab, Dr. Marjatta Leirisalo-Repo, professor of rheumatology at Helsinki University Central Hospital and the University of Helsinki, said at the annual meeting of the American College of Rheumatology.
The study enrolled 100 patients with rheumatoid arthritis (RA) of less than 1 year's duration from 15 centers, randomizing them to methotrexate, sulfasalazine, hydroxychloroquine, and prednisone plus either infliximab or placebo for 6 months. Mean age was 46 years, median symptom duration was 4 months, mean number of swollen joints was 15 and of tender joints, 20. All had morning stiffness of 45 minutes or more. The mean baseline erythrocyte sedimentation rate (ESR) was 33 mm/hr and mean Health Assessment Questionnaire (HAQ) score was 1. In all, 67% were female and 68% were rheumatoid factor positive. None had prior disease-modifying antirheumatic drug (DMARD) treatment.
The DMARD regimens were individually tailored, with maximum dosages of methotrexate of 25 mg/wk and maximum dosages of sulfasalazine of 2 g/day. Hydroxychloroquine was given in dosages of 35 mg/kg a week and prednisone in dosages of 7.5 mg/day. Patients randomized to receive infliximab had the tumor necrosis factor blocker in dosages of 3 mg/kg at weeks 4, 6, 10, 18, and 26. Remission was defined as less than 15 minutes of morning stiffness; no fatigue or painful, swollen, or tender joints; and an ESR less than 30 mm/h.
At 6 months, an overall total of 53% of patients had achieved remission. The percentages of patients in remission at 6 months in the infliximab and placebo groups were 58% and 47%, respectively (58% and 52% at 12 months).
At 6 months, 63% of placebo patients with a body mass index (BMI) of less than 25 kg/m
Obesity is associated with a lack of response to conventional DMARDs, but infliximab was able to overcome this resistance, said Dr. Leirisalo-Repo, who disclosed she has received research grants from Schering-Plough Oy in Finland.