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Effect of Disease Activity, Glucocorticoid Exposure, and Rituximab on Body Composition During Induction Treatment of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Author(s) -
Wallace Zachary S.,
Miloslavsky Eli M.,
Cascino Matthew,
Unizony Sebastian H.,
Lu Na,
Hoffman Gary S.,
Kallenberg Cees G. M.,
Langford Carol A.,
Merkel Peter A.,
Monach Paul A.,
Seo Philip,
Spiera Robert,
St.Clair E. William,
Specks Ulrich,
Brunetta Paul,
Choi Hyon K.,
Stone John H.
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23099
Subject(s) - medicine , rituximab , glucocorticoid , vasculitis , body mass index , anti neutrophil cytoplasmic antibody , gastroenterology , disease , immunology , lymphoma
Objective We investigated the relationships between glucocorticoid use, disease activity, and changes in body mass index (BMI) in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV). Methods We analyzed AAV patients enrolled in the Rituximab in AAV trial. Glucocorticoid use, BMI, and disease activity were measured regularly during the trial period. We performed mixed‐effects regressions to examine the associations of time‐dependent cumulative average glucocorticoid use and disease activity with changes in BMI over time, while adjusting for potential confounders. Results The mean ± SD baseline BMI of the 197 patients enrolled was 28.8 ± 6.3 kg/m 2 . Patients with newly diagnosed AAV tended to have a lower mean ± SD BMI than those with relapsing disease (28.0 ± 5.7 kg/m 2 versus 29.6 ± 6.8 kg/m 2 ) and higher disease activity (mean ± SD Birmingham Vasculitis Activity Score for Wegener's Granulomatosis 8.7 ± 3.3 versus 7.4 ± 2.7). The most significant change in BMI occurred during the first 6 months of the trial (mean ± SD increase of 1.1 ± 2.2 kg/m 2 ; P < 0.0001). Disease activity improvement, glucocorticoid exposure, and randomization to rituximab were each independently associated with an increase in BMI ( P < 0.001 for all analyses). Conclusion Our findings suggest that changes in BMI, as well as glucocorticoid exposure, are independently associated with improvements in disease activity in AAV. Rituximab may also have effects on BMI independent of its impact on disease activity.