Treatment with tumor necrosis factor-inhibitors (TNFi) was associated with significant increases in body weight and body mass index (BMI), according to study data published in the Journal of the American Academy of Dermatology.
Investigators conducted a systematic review of the MEDLINE, Embase, and Cochrane databases for observational studies and randomized trials of biologics treatment for psoriasis. Extracted outcomes of interest were changes in body weight and BMI in patients after approximately 24 weeks of biologics exposure. Changes in body weight and BMI were reported as a mean difference (MD) between patients receiving biologics and patients receiving conventional therapies. Specific biologics included TNFi, anti-interleukin (IL)-12/23, and anti-IL-17 drugs; conventional therapies included methotrexate, cyclosporine, and acitretin. A network meta-analysis was introduced to account for the lack of direct comparisons among conventional therapy and anti-IL-12/23 and anti-IL-17 biologics. The Newcastle-Ottawa Scale was used to assess risk for bias.
Six studies were selected for inclusion; a pooled cohort of 862 patients was available for meta-analysis. The risk for bias among included studies was generally low. Compared with conventional systemic treatments, treatment with TNFi was associated with a significant increase in body weight (MD, 1.40 kg; 95% CI, 0.88-1.93 kg). Specifically, the MDs in body weight among patients receiving conventional therapy and patients receiving infliximab, etanercept, and adalimumab were 1.33 (95% CI, -0.34 to 2.32), 1.14 (95% CI, 0.54-1.75), and 2.30 (95% CI, 1.20-3.40) kg, respectively. TNFi use was also associated with a BMI increase of 0.39 kg/m2 (95% CI, 0.24-0.54) when compared with conventional therapy. Stratified analysis of infliximab, etanercept, and adalimumab showed mean BMI increases of 0.47 kg/m2 (95% CI, 0.22-0.73), 0.30 kg/m2 (95% CI, 0.16-0.44), and 0.82 kg/m2 (95% CI, 0.32-1.32). No significant increases in body weight or BMI were observed among patients receiving IL-12/23 or IL-17 biologics.
Study limitations include between-study heterogeneity and the lack of long-term follow-up data.
These data support a relationship between TNFi treatment and increased body weight. The same trend was not observed for anti-IL-12/23 and anti-IL-17 biologics. “The potential effect of TNFi treatments on [body weight] could be one of the considerations in the care of overweight and obese psoriasis patents,” investigators concluded. Decreased treatment response resulting from body weight gain associated with TNFi use should be examined in further prospective studies, they suggested.
Disclosure: One study author declared affiliations with the pharmaceutical industry.
Please see the original reference for a full list of authors’ disclosures.
Wu MY, Yu CL, Yang SJ, Chi CC. Change in body weight and body mass index in psoriasis patients receiving biologics: a systematic review and network meta-analysis [published online August 7, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.07.103