Exploring the impact of conventional and targeted DMARDs on body weight in patients with PsA

To evaluate change in body weight with DMARDs in PsA.

We analysed data from a large cohort of PsA patients with at least two weight measurements over follow-up. The absolute weight difference at one year from drug initiation was evaluated across-no medications or NSAIDs, conventional synthetic (cs) DMARDs, tumour necrosis factor inhibitors (TNFi), IL-12/23 inhibitor (i), IL-17i, IL-23i, Janus kinase inhibitors (JAKis) and apremilast classes. Two separate linear mixed models examined trends in weight change before and after treatment initiation with change-point modelling and factors affecting weight over follow-up.

Of 1754 patients, 473 were on NSAIDs or no medications, 571 on csDMARDs, 702 on bDMARDs, 42 on JAKi and 70 on apremilast. Compared with weight at drug initiation, TNFi was associated with a weight gain at one year (1.54 kg, P < 0.01), whereas no significant change was observed with other drug classes. On change-point modelling, a significant decrease in the rate of weight change was observed following IL-17i (slope 0.63 ± 0.20 vs -0.26 ± 0.25, P < 0.01), IL-23i (0.82 ± 0.34 vs -0.56 ± 0.56, P < 0.01) and csDMARDs (0.43 ± 0.24 vs -0.20 ± 0.26, P < 0.01) compared with before treatment initiation. Factors associated with weight gain over follow-up included TNFi, IL12/23i use, male sex, follow-up duration and higher baseline weight, while with weight loss were apremilast, older age and diabetes mellitus.

The rate of weight gain significantly decreases following the initiation of IL-17i, IL-23i and csDMARDs in PsA. Overall, TNFi and IL12/23i use is associated with weight gain, while apremilast with weight loss.