FRom the American College of Rheumatology (ACR):
Weight Gain Associated with the Administration of Tumor Necrosis Factor

Alpha Antagonists in Patients with Rheumatoid Arthritis
Category:  17 RA-treatment
J E Fonseca1, H Canhão2, M Cruz1, B Valério1, W Castelão2, T
Mesquita1, C
Resende2, C Macieira2, J A Pereira da Silva2, J Branco1, M Viana
Queiroz2
1Hospital Egas Moniz, Lisbon, Portugal2Hospital de Santa Maria, Lisbon,

Portugal
Presentation Number: 367
Poster Board Number: 367
Keywords: Rheumatoid arthritis, Tumor necrosis factor alpha, Weight
gain
Introduction: Tumor necrosis factor alpha (TNF a) is able to block
lipoprotein lipase activity in cultured adipocytes and in animal models
its
administration causes cachexia, through the induction of lipid and
protein
catabolism, enhanced release of free fatty acids and suppression of
appetite. Having considered these known biochemical effects of TNF a it
is
reasonable to expect that TNF a antagonist therapy might cause a change
in
the metabolism resulting in an increased weight.
Objectives: Clarify if TNF a antagonist therapy is associated with
weight
gain.
Material and Methods: We have prospectively evaluated 46 rheumatoid
arthritis patients submitted to this therapy (30 treated with
intravenous
infliximab 3mg/Kg 0, 2, 6 and then every 8 weeks and 16 with
subcutaneous
etanercept 25 mg twice weekly).
Results: 6 patients were males and 40 were females, with a mean age of
53.1
± 12.6 years. DAS28 mean initial value for the patients treated with
infliximab was 6.1 ± 1.3 and for the patients treated with etanercept
was
6.9 ± 1.1. Prednisone mean initial dose was 8.1 ± 3.9 mg/day
(infliximab)
and 8.0 ± 3.3 mg/day (etanercept). After a mean follow-up of 10.7 ±
4.8
months DAS28 mean final value was 3.5 ± 1.4 for the infliximab group
and 3.9
± 1.1 for the etanercept group (a significative reduction from the
baseline
DAS28, p<0.01). After this period of therapy the prednisone mean final
dose
was 6.2 ± 3.8 mg/day for the infliximab group and 6.4 ± 1.8 mg/day
for the
etanercept group (a significative reduction from the baseline
prednisone
dose, p<0.05). During this period of time the methotrexate dose
remained
stable. 8 patients had to stop therapy after 3 months: 5 patients in
the
infliximab group (sepsis, heart failure, central nervous system tumor,
sudden death, lack of efficacy), 3 patients in the etanercept group
(septic
arthritis, cervix carcinoma, hip fracture). The mean initial weight was
70.1
± 13.7 Kg and the mean final weight was 73.3 ± 13.9 Kg, corresponding
to a
mean weight gain of 3.2 ± 3.7 Kg (p<0.001, 95% mean confidence
interval 2.0-
4.3). The weight gain was observed in 40 (87%) patients. When a
separate
analysis of the 2 groups was performed we verified also a significative

weight gain. (respectively, infliximab group from 71.9 ± 12.9 Kg to
74.9 ±
13.7 Kg, p<0.001, mean confidence interval 95% 1.6-4.3; etanercept
group
from 67.0 ± 14.9 Kg to 70.5 ± 14.2 Kg, p=0.004, mean confidence
interval 95%
1.3-5.7).
Discussion: Despite the reduction in the prednisone dose this group of
patients suffered weight gain. Although the improvement of a systemic
disease, such as rheumatoid arthritis, can increase the appetite and
weight,
we hypothesize that this effect might be enhanced by a catabolic
suppression
and/or an anabolic effect induced by TNF a antagonist therapy.

Can't agree with you on this one Harv.  I was thirty when I took my first
prednisone pill.  I weighed 105 pounds and had never weighed more than 120
in my life.  Six months later, my asthma was finally under some sort of
control but I weighed 150 pounds.  We are all human around here and there
are limits on what a person can do.  I would have had to cut my food intake
in half to have avoided that weight gain.  At that point homicide or suicide
would have been very real possibilities.

Every time I go through a prednisone pulse, my metabolism soars.  Along with
my appetite.  And I'm not talking the kind of appetite of wanting to indulge
myself.  I'm talking about appetite as strong as the desire to breathe air
or drink water.  I quit a two pack a day cigarette habit.  That was easy
compared to trying to avoid food while on prednisone.

Where I run into the worst problem is after the prednisone pulse.  My
metabolism plummets but my appetite doesn't.

Jo

No, that is not why I am gaining, I have been going to WW for over 3 years
and had made lifetime 2 years ago and go every week still to meetings, with
my mom, and I did not start gaining until I started he mtx, the more it was
upped the more I gained, if I eat the amount of points that I did I will put
on weight for some reason now, but if I lower them I am able to hold it for
a week or so, so now since I am still on eh MTX 17.5, I have learned that I
can only eat so much or I will still go up, I don't know why it is just want
that drug does to me, that is why I didn't want to start the enbrel if it
can do it to, I may talk to my doctor about a trial of it like suggested.,
would rather go off the mtx and then try the enbrel but not sure if he would
recommend that , I see him again on the 17th of next month . He still keeps
saying it is not the MTX, but after he saw my food journals, and I write
everything even if I cheat that is over my points, he is starting to believe
me, I still go to the gym the same amount of time and take the dogs for
walks, so he is starting to believe that for some reason the MTX is doing
that, I did show him a  couple emails from other people that also had the
same thing happen to them.
Anyway, thank you all or the advice, this group is always a good one,
wishing everyone a good weekend ahead.
Becky