TNF inhibitors cause Weight Gain & Fat Increase

My post, Do TNF inhibitors make you put on weight? , is a very popular post and has been accessed thousands of times. I encourage you to check out the comments.

While blog comments are clearly not considered  high level scientific evidence, the interest and sheer volume make me take this potential problem seriously.

Based on this post,  a pharmaceutical representative very helpfully reached out to me and offered the services of her company to perform a literature search on this topic.

I figured there would be lots of you interested so here is a list of references:

Psoriasis / Psoriatric arthritis / Spondyloarthritis 

• Tan E, Baker C, Foley P. Weight gain and tumour necrosis factor-alpha inhibitors in patients with psoriasis. Australasian Journal of Dermatology. 54 (4) (pp 259-263), 2013.
• Puig L. Anti-tumour necrosis factor-alpha treatment and weight gain in psoriasis: The 'pudgy blanching' conundrum. British Journal of Dermatology. 168 (5) (pp 923-924), 2013.
• Gisondi P, Cotena C, Tessari G, Girolomoni G. 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; 22:341–4.
• 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; 57:290–5.
• Esposito M, Mazzotta A, Saraceno R et al. Influence and variation of the body mass index in patients treated with etanercept for plaque-type psoriasis. Int J Immunopathol Pharmacol 2009; 22:219–25.
• Florin V, Cottencin AC, Delaporte E, Staumont-Salle ́ D.  Body weight increment in patients treated with infliximab for plaque psoriasis. J Eur Acad Dermatol Venereol 2013; 27:e186–90.
• Prignano F. Ricceri F. Pescitelli L. Buggiani G. Troiano M. Zanieri F. Rossari S. Lotti T. Comparison of body weight and clinical-parameter changes following the treatment of plaque psoriasis with biological therapies. Current Medical Research and Opinion. 25 (9) (pp 2311-2316), 2009.
• Mahe ́ E, Reguiai Z, Barthelemy H et al. Evaluation of risk factors for body weight increment in psoriatic patients on infliximab: a multicentre, cross- sectional study. J Eur Acad Dermatol Venereol 2012; doi: 10.1111/jdv.12066. 
• Di RenzoL, Saraceno R, Schipani C et al. Prospective assessment of body weight and body composition changes in patients with psoriasis receiving anti- TNF-a treatment. Dermatol Ther 2011; 24:446–51.
• Briot K, Garnero P, Le Henanff A et al. Body weight, body composition, and bone turnover changes in patients with spondyloarthropathy receiving anti-tumour necrosis factor a treatment. Ann Rheum Dis 2005; 64:1137–40. 
• Briot K, Gossec L, Kolta S et al. Prospective assessment of body weight, body composition, and bone density changes in patient with spondyloarthropathy receiving anti-tumor necrosis factor- alpha treatment. J Rheumatol 2008; 35:855–61. 

Rheumatoid arthritis & related inflammatory disorders

• Alcorn N, Tierney A, Wu O et al. Impact of anti-tumour necrosis factor therapy on the weight of patients with rheumatoid arthritis. Ann Rheum Dis 2010; 69:1571. 
• Younis S; Rosner I; Rimar D; Boulman N; Rozenbaum M; Odeh M; Slobodin G. Weight change during pharmacological blockade of interleukin-6 or tumor necrosis factor-alpha in patients with inflammatory rheumatic disorders: a 16- week comparative study. Cytokine. 61(2):353-5, 2013. 
• Toussirot E. Dumoulin G. Effects of TNF-alpha inhibitors on abdominal adiposity in patients with inflammatory rheumatic diseases. Journal of Rheumatology. 41 (12) (pp 2491), 2014. 
• Toussirot E. Mourot L. Dehecq B. Wendling D. Grandclement E. Dumoulin G. TNF-alpha blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: A 2- year prospective study. European Journal of Nutrition. 53 (3) (pp 951-961), 2014 
• Engvall IL, Tengstrand B, Brismar K, Hafström I. Infliximab therapy increases body fat mass in early rheumatoid arthritis independently of changes in disease activity and levels of leptin and adiponectin: a randomised study over 21 months. Arthritis Research and Therapy. 2010;12(5, article R197) 

I haven’t read these all. I read a few that I could get my hands on and skimmed some abstracts.

In short, it does seem like a true effect.

TNF inhibitors do seem to lead to an increase in weight, BMI and a change in body composition with a frustrating increase in abdominal adipose tissue.

What’s unclear is why this doesn’t happen to all patients, why some patients seem to be affected much more, and what the actual mechanism of this effect is?

These descriptive studies also do not really tackle if we can avoid this with appropriate exercise and being mindful about diet and nutrition. 

Our interest at BJC Health on a holistic approach means we typically do try to improve our patient’s lifestyle choices.

I have to make it clear that in my own cohort of patients on TNF inhibitor therapy, it is only a small minority who seem to develop significant weight gain. 

Maybe, I need to measure it more diligently. I likely need to ask the question more and to make my patients more aware of the possibility of weight gain. 

I’d be prepared to bet there’s more than a few of you ready to comment. Please do share your experiences and thoughts.