Re: Enbrel = Weight Gain???


FRom the American College of Rheumatology (ACR):
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 Maria, Lisbon,

Portugal
Presentation Number: 367
Poster Board Number: 367
Keywords: Rheumatoid arthritis, Tumor necrosis factor alpha, Weight
gain
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.

.

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