PurposeWe determined if metabolic syndrome, its components, and adipokines (adiponectin, leptin, Fibroblast Growth Factor‐21) were associated with response to advanced therapies among patients with rheumatoid arthritis (RA).MethodsThis study included participants with RA initiating either TNFi or non‐TNFi biologic therapies from the Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) cohort within the CorEvitas registry. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III definition. Adipokines were assessed on stored samples from a sub‐sample of responders and non‐responders (N=200). The primary outcome was the achievement of a change as large as the minimal clinically important difference (MCID) for the Clinical Disease Activity Index (CDAI) at 6 months.ResultsAmong 2,368 participants, 687 (29%) had metabolic syndrome. Metabolic syndrome was associated with lower odds of achieving CDAI MCID [OR (95% CI): 0.69 (0.56,0.86) p=0.001] with a dose‐dependent decrease in response rate according to the number of components present. Model fit was superior for metabolic syndrome compared to BMI. Associations between metabolic syndrome and MCID achievement were similar between patients receiving TNFi [OR (95% CI): 0.65 (0.49,0.87) p=0.003] v. non‐TNF therapies [OR (95% CI): 0.76 (0.55,1.04) p=0.08)] (p‐for‐interaction=0.49). Adipokines were not associated with MCID achievement.ConclusionsMetabolic syndrome is associated with lower response rates with the initiation of an advanced therapy in RA, with similar effects for both TNFi and non‐TNFi agents. Adipokines were strongly associated with metabolic syndrome but were not associated with clinical response.

中文翻译：

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类风湿性关节炎的代谢综合征、脂肪因子和对先进疗法的反应


目的我们确定了代谢综合征、其成分和脂肪因子（脂联素、瘦素、成纤维细胞生长因子 21）是否与类风湿性关节炎 （RA） 患者对先进疗法的反应相关。方法这项研究包括从比较有效性登记处开始 TNFi 或非 TNFi 生物疗法的 RA 参与者，以研究 CorEvitas 登记处内的关节炎和炎症疗法 （CERTAIN） 队列。代谢综合征是根据国家胆固醇教育计划成人治疗小组 III 定义定义的。对来自反应者和无反应者的子样本 （N=200） 的储存样本评估脂肪因子。主要结局是 6 个月时达到临床疾病活动指数 （CDAI） 的最小临床重要差异 （MCID） 的变化。结果在 2,368 名参与者中，687 名 （29%） 患有代谢综合征。代谢综合征与达到 CDAI MCID 的较低几率相关 [OR （95% CI）：0.69 （0.56,0.86） p=0.001]，根据存在的成分数量，反应率呈剂量依赖性降低。与 BMI 相比，代谢综合征的模型拟合效果更好。接受 TNFi [OR（95% CI）：0.65 （0.49,0.87） p=0.003] 与非 TNF 治疗 [OR（95% CI）：0.76 （0.55,1.04） p=0.08）] （p-for-相互作用=0.49） 之间的相关性相似。脂肪因子与 MCID 成就无关。结论代谢综合征与 RA 开始先进治疗后反应率降低相关，对 TNFi 和非 TNFi 药物的影响相似。脂肪因子与代谢综合征密切相关，但与临床反应无关。