Weight gain in patients receiving anti–tumor necrosis factor agents?
Jeffrey M. Weinberg, MD
October 10, 2008
Question:
Most of our patients on anti–tumor necrosis factor (TNF) drugs for psoriasis have put on a lot of weight since treatment was commenced. Is TNF-alpha normally associated with a mechanism for weight control that is lost when these drugs are used? Answer:
For several years, weight gain has been noted anecdotally in some patients on TNF inhibitors. TNF-alpha is known to be an important mediator of cachexia and is deeply involved in body weight homeostasis, which may be affected by TNF-alpha-targeted therapy.
Gisondi et al investigated whether TNF-inhibitor treatment is associated with changes in body weight in patients with chronic plaque psoriasis.1 They performed a retrospective controlled analysis comparing the variations in body weight and body mass index (BMI) in three closed cohorts of psoriasis patients during a 6-month treatment with etanercept (N=58), infliximab (N=40), or methotrexate (N=43). In the analysis, they observed a body weight increment of 1.5 +/- 2.7 kg (mean +/- SD; P=0.0002) and 2.5 +/- 3.3 kg (P=0.004) in patients treated with etanercept and infliximab, respectively. In contrast, a nonsignificant change (0.6 +/- 1.4 kg; P=0.4) was measured in patients treated with methotrexate. BMI increased 0.5 +/- 0.5 (P=0.01) and 0.8 +/- 1 (P=0.003) points in patients treated with etanercept and infliximab, respectively, whereas it did not change (<0.2 +/- 0.5; P=0.06) in patients treated with methotrexate. Approximately 25% of patients experienced a 4-to-10-kg weight gain. The differences in body weight variations among patients treated with TNF inhibitors and methotrexate were statistically significant (P=0.0005).1
Saraceno et al similarly investigated retrospectively the effect of anti-TNF therapies on body weight and BMI in patients with psoriasis treated with infliximab, etanercept, adalimumab (anti-TNF-alpha group), efalizumab, or methotrexate (control group).2 The patients were treated for 48 weeks. BMI, weight, and disease activity were measured at baseline (week 0) and weeks 12, 24, and 48. At week 24, a significant increase in body weight and BMI relative to the control group was observed in the anti-TNF-alpha treatment group.
The data suggest that patients with psoriasis treated with long-term TNF-inhibitors may manifest a body weight gain. This effect should be taken into account in the global approach to patients with psoriasis.1
References
1. Gisondi P, Cotena C, Tessari G, et al. Anti-tumour necrosis factor-alpha therapy increases body weight in patients with chronic plaque psoriasis: a retrospective cohort study. J Eur Acad Dermatol Venereol. 2008;22:341-344.
2. Saraceno R, Schipani C, Mazzotta A, et al. Effect of anti-tumor necrosis factor-alpha therapies on body mass index in patients with psoriasis. Pharmacol Res. 2008;57:290-295.
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