{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:10:00Z","timestamp":1788916200521,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,7,27]],"date-time":"2016-07-27T00:00:00Z","timestamp":1469577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Veterans Affairs Clinical Science Research and Development Career Development Award","award":["IK2-CX000955"],"award-info":[{"award-number":["IK2-CX000955"]}]},{"name":"K24 Mid-Career Development Award from the National Institutes of Musculoskeletal and Skin Disorders","award":["1K24-AR-055259-01"],"award-info":[{"award-number":["1K24-AR-055259-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Unintentional weight loss is important and can be predictive of long\u2010term outcomes in patients with rheumatoid arthritis (RA). This study was undertaken to assess how primary therapies for RA may influence changes in body mass index (BMI) in RA patients from a large administrative database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Unique dispensing episodes of methotrexate, prednisone, leflunomide, and tumor necrosis factor inhibitors (TNFi) administered to RA patients were identified from the US Department of Veterans Affairs pharmacy databases. Values for C\u2010reactive protein (CRP) level and BMI closest to the time point within 30 days of the treatment course start date and at follow\u2010up time points were linked. Missing laboratory values were imputed. Weight loss was defined as a decrease in BMI of &gt;1 kg\/m<jats:sup>2<\/jats:sup>. Regression models were used to evaluate changes in BMI during each drug treatment as compared to treatment with methotrexate. To assess the impact of confounding by indication, propensity scores for use of each drug were incorporated in analyses using matched\u2010weighting techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 52,662 treatment courses in 32,859 RA patients were identified. At 6 months from the date of prescription fill, weight gain was seen among patients taking methotrexate, those taking prednisone, and those taking TNFi. On average, compared to methotrexate\u2010treated patients, prednisone\u2010treated patients had significantly more weight gain, while leflunomide\u2010treated patients demonstrated weight loss. In multivariable models, more weight loss (\u03b2\u2009=\u2009\u22120.41 kg\/m<jats:sup>2<\/jats:sup>, 95% confidence interval [95% CI] \u22120.46, \u22120.36; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and a greater risk of weight loss (odds ratio 1.73, 95% CI 1.55, 1.79; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) were evident among those receiving leflunomide compared to those receiving methotrexate. Treatment with prednisone was associated with greater weight gain (\u03b2\u2009=\u20090.072 kg\/m<jats:sup>2<\/jats:sup>, 95% CI 0.042, 0.10; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). These associations persisted in analyses adjusted for propensity scores and in sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Leflunomide is associated with significantly more, but modest, weight loss, while prednisone is associated with greater weight gain compared to other therapies for RA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.39647","type":"journal-article","created":{"date-parts":[[2016,2,16]],"date-time":"2016-02-16T10:41:00Z","timestamp":1455619260000},"page":"1818-1827","source":"Crossref","is-referenced-by-count":43,"title":["Changes in Body Mass Related to the Initiation of Disease\u2010Modifying Therapies in Rheumatoid Arthritis"],"prefix":"10.1002","volume":"68","author":[{"given":"Joshua F.","family":"Baker","sequence":"first","affiliation":[{"name":"Philadelphia VA Medical Center and University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Medical Center and University of Utah Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Medical Center and University of Utah Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Chen","family":"Teng","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Medical Center and University of Utah Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases Wichita Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Jorgenson","sequence":"additional","affiliation":[{"name":"Philadelphia VA Medical Center and University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Davis","sequence":"additional","affiliation":[{"name":"Denver VA Medical Center Denver  Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liron","family":"Caplan","sequence":"additional","affiliation":[{"name":"Denver VA Medical Center Denver  Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Cannella","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, VA Nebraska\u2013Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, VA Nebraska\u2013Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,7,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq232"},{"key":"e_1_2_6_3_1","first-page":"2350","article-title":"Relation between body mass index and radiological progression in patients with rheumatoid arthritis","volume":"30","author":"Kaufmann J","year":"2003","journal-title":"J 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