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The Interrelations between Biological and Targeted Synthetic Agents Used in Inflammatory Joint Diseases, and Obesity or Body Composition

Authors
  • Toussirot, Eric1, 2, 3, 4, 5
  • 1 ; Tel.: +33-3-81-21-89-97
  • 2 Fédération Hospitalo-Universitaire INCREASE, CHU de Besançon, 25000 Besançon, France
  • 3 CHU de Besançon, Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), 25000 Besançon, France
  • 4 Département Universitaire de Thérapeutique, Université de Bourgogne Franche-Comté, UFR des Sciences Médicales et Pharmaceutiques de Besançon, CS 71806, 25030 Besançon Cedex, France
  • 5 INSERM UMR1098, Relations Hôte Greffon Tumeurs, ingénierie cellulaire et génique, Université de Bourgogne Franche-Comté, 25000 Besançon, France
Type
Published Article
Journal
Metabolites
Publisher
MDPI
Publication Date
Mar 13, 2020
Volume
10
Issue
3
Identifiers
DOI: 10.3390/metabo10030107
PMID: 32183053
PMCID: PMC7175105
Source
PubMed Central
Keywords
License
Green

Abstract

Obesity is a comorbidity that plays a role in the development and severity of inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. The relationships between obesity and adipose tissue and the treatments given for inflammatory joint diseases are bidirectional. In fact, biological agents (bDMARDs) and targeted synthetic agents (tsDMARDs) may influence body weight and body composition of treated patients, while obesity in turn may influence clinical response to these agents. Obesity is a prevalent comorbidity mainly affecting patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) with specific phenotypes. Tumour necrosis factor alpha (TNFα) inhibitors have been associated with changes in body composition by improving lean mass, but also by significantly increasing fat mass, which localized toward the abdominal/visceral region. The IL-6 inhibitor tocilizumab is associated with an increase in lean mass without change in fat mass. The clinical response to TNFα inhibitors is attenuated by obesity, an effect that is less pronounced with IL-6 inhibitors and the B-cell depletion agent rituximab. Conversely, body weight has no influence on the response to the costimulation inhibitor abatacept. These effects may be of help to the physician in personalized medicine, and may guide the therapeutic choice in obese/overweight patients.

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