Effect of metabolic surgery on immunosuppressive medication use in patients with rheumatic diseases

Obesity is an inflammatory condition associated with higher rheumatic disease (RD) incidence, increased disease activity, and functional impairment.

We aimed to assess whether metabolic and bariatric surgery (MBS) decreases immunosuppressant use in patients with RD.

Bariatric surgery academic centers of excellence.

We conducted a retrospective review of MBS procedures in patients using immunosuppressants for RD between 2008 and 2020 at 2 academic institutions. Patient data were analyzed at 3-, 6-, 12-, and 24-month follow-up intervals. We examined paired differences in the number of preoperative medications relative to different postoperative follow-up periods using McNemar tests for the prednisone-only comparisons and paired t tests for all other comparisons.

We identified 53 patients with RD who underwent MBS (mean age = 53 years; mean follow-up = 19 months). Of these patients, 64% had Roux-en-Y gastric bypass, 30% sleeve gastrectomy, and 6% duodenal switch. Rheumatoid arthritis was the most common RD (42%), followed by psoriasis (19%) and lupus (11%). Mean percent total weight loss and change in body mass index were 31.3% and 15.9 kg/m², respectively, at 24-month follow-up. At 24 months, 10 patients (30%) stopped prednisone (P = .007), and 13 patients (33%) showed a reduction in immunosuppressant use (disease-modifying antirheumatic drugs or glucocorticoids) (P = .01). One patient started glucocorticoids postoperatively, and 2 patients had an increase in immunosuppressant use. At the last encounter, 5 patients were off immunosuppressants, and all medication classes, except biological disease-modifying antirheumatic drugs, showed significant reductions.

There is significant decrease in the use of immunosuppressant agents after MBS in patients with RD. Further studies are needed to confirm the correlation.