RE: Weight Gain Associated with the Administration of Tumor NecrosisFactor Alpha Antagonists in Patients with Rheumatoid Arthritis

[Guest guest]

Yikes! I’d swear my appetite has increased since I’ve been on the Remicade,

also. I’ve gained a couple of pounds, and more importantly I’m having

trouble beginning a diet plan. I just can’t motivate myself to stick to it.

I’ll be interested to see what else comes up regarding weight gain and the

biologics.

Love to all,

Carol

[ ] Weight Gain Associated with the Administration of

Tumor NecrosisFactor Alpha Antagonists in Patients with Rheumatoid Arthritis

Weight Gain Associated with the Administration of Tumor Necrosis Factor

Alpha Antagonists in Patients with Rheumatoid Arthritis

Category: 17 RA-treatment

J E Fonseca1, H Canhão2, M Cruz1, B Valério1, W Castelão2, T Mesquita1, C

Resende2, C Macieira2, J A Pereira da Silva2, J Branco1, M Viana Queiroz2

1Hospital Egas Moniz, Lisbon, Portugal2Hospital de Santa , Lisbon,

Portugal

Introduction: Tumor necrosis factor alpha (TNF a) is able to block

lipoprotein lipase activity in cultured adipocytes and in animal models its

administration causes cachexia, through the induction of lipid and protein

catabolism, enhanced release of free fatty acids and suppression of

appetite. Having considered these known biochemical effects of TNF a it is

reasonable to expect that TNF a antagonist therapy might cause a change in

the metabolism resulting in an increased weight.

Objectives: Clarify if TNF a antagonist therapy is associated with weight

gain.

Material and Methods: We have prospectively evaluated 46 rheumatoid

arthritis patients submitted to this therapy (30 treated with intravenous

infliximab 3mg/Kg 0, 2, 6 and then every 8 weeks and 16 with subcutaneous

etanercept 25 mg twice weekly).

Results: 6 patients were males and 40 were females, with a mean age of 53.1

± 12.6 years. DAS28 mean initial value for the patients treated with

infliximab was 6.1 ± 1.3 and for the patients treated with etanercept was

6.9 ± 1.1. Prednisone mean initial dose was 8.1 ± 3.9 mg/day (infliximab)

and 8.0 ± 3.3 mg/day (etanercept). After a mean follow-up of 10.7 ± 4.8

months DAS28 mean final value was 3.5 ± 1.4 for the infliximab group and 3.9

± 1.1 for the etanercept group (a significative reduction from the baseline

DAS28, p<0.01). After this period of therapy the prednisone mean final dose

was 6.2 ± 3.8 mg/day for the infliximab group and 6.4 ± 1.8 mg/day for the

etanercept group (a significative reduction from the baseline prednisone

dose, p<0.05). During this period of time the methotrexate dose remained

stable. 8 patients had to stop therapy after 3 months: 5 patients in the

infliximab group (sepsis, heart failure, central nervous system tumor,

sudden death, lack of efficacy), 3 patients in the etanercept group (septic

arthritis, cervix carcinoma, hip fracture). The mean initial weight was 70.1

± 13.7 Kg and the mean final weight was 73.3 ± 13.9 Kg, corresponding to a

mean weight gain of 3.2 ± 3.7 Kg (p<0.001, 95% mean confidence interval 2.0-

4.3). The weight gain was observed in 40 (87%) patients. When a separate

analysis of the 2 groups was performed we verified also a significative

weight gain. (respectively, infliximab group from 71.9 ± 12.9 Kg to 74.9 ±

13.7 Kg, p<0.001, mean confidence interval 95% 1.6-4.3; etanercept group

from 67.0 ± 14.9 Kg to 70.5 ± 14.2 Kg, p=0.004, mean confidence interval 95%

1.3-5.7).

Discussion: Despite the reduction in the prednisone dose this group of

patients suffered weight gain. Although the improvement of a systemic

disease, such as rheumatoid arthritis, can increase the appetite and weight,

we hypothesize that this effect might be enhanced by a catabolic suppression

and/or an anabolic effect induced by TNF a antagonist therapy.

[Guest guest]

Carol-

Yikes is right .... I was hoping the Remicade would help me lose weight by

helping me get off pred. Hope this is not true for everyone. I feel huge after

all the years of pred.

Hugs, K