According to a retrospective study presented at the American College of Rheumatology Convergence, antiobesity medication use among patients with rheumatoid arthritis (RA) may yield multiple clinical benefits, including significant weight loss, improvements in inflammatory markers, reductions in pain, and enhanced lipid profiles.

Noting that the US Food and Drug Administration (FDA) recently approved the antiobesity medications semaglutide and tirzepatide, which have demonstrated efficacy in promoting weight loss, the investigators observed that their specific effects on patients with RA remain largely unexplored. This study aimed to evaluate the clinical and laboratory outcomes associated with antiobesity medications use in patients with RA. 

The researchers analyzed data from 554 patients with an electronic medical record diagnosis of RA who were prescribed semaglutide or tirzepatide. Following detailed chart reviews, RA was confirmed as a primary diagnosis for 229 patients in 2 or more rheumatology notes; 152 of these patients initiated treatment with antiobesity medication . Demographic, clinical, and laboratory data, including weight, obesity-related comorbidities, RA therapies, and adverse events, were abstracted at 3-month intervals for up to 1-year post-AOM initiation. A linear mixed-effects model was employed to assess changes in clinical and laboratory outcomes over time. 

The study cohort had a mean age of 58.1 years and was predominantly female (90.1%). Common obesity-related comorbidities included dyslipidemia (59.9%), diabetes (51.3%), hypertension (56.6%), and coronary artery disease (16.4%). Nearly all patients were prescribed semaglutide (93.4%); the remainder received tirzepatide (6.6%). 

Significant reductions were observed across several parameters during the study period. Weight and reductions in body mass index showed a marked decrease reflecting effective weight loss. Lower erythrocyte sedimentation rates and C-reactive protein levels were indicative of reduced systemic inflammation. Reductions in total cholesterol, low-density lipoprotein, and triglycerides highlighted potential cardiovascular benefits. Patients also evidenced improvements in the pain visual analogue scale (VAS).

Approximately 15% of patients experienced adverse events, primarily gastrointestinal side effects. Discontinuation of antiobesity medication occurred in 42 cases, with the most common reasons being gastrointestinal intolerance (23.8%), insurance-related challenges (26.2%), and perceived inefficacy (9.5%). 

This retrospective study suggests that use of antiobesity therapy in patients with RA may yield multiple clinical benefits, including significant weight loss, improvements in inflammatory markers, reductions in pain levels, and enhanced lipid profiles. These findings indicate that medications such as semaglutide and tirzepatide could offer a dual benefit in managing obesity and RA-related inflammation, potentially reducing cardiovascular risks and alleviating RA symptoms. 

However, challenges remain, the investigators pointed out, particularly with gastrointestinal side effects and insurance barriers contributing to treatment discontinuation. Further prospective studies are necessary to confirm these findings and assess the direct impact of antiobesity medications on RA disease activity and remission rates.

Reference
Dente E. Effects of antiobesity medications in RA patients. Presented at: American College of Rheumatology Convergence. November 14-19, 2024; Washington, DC.