Table 1.
TNFI | Structure and Mechanism | Effect on BMI/Weight Gain | Influence of BMI on Drug Efficacy | Commentary |
---|---|---|---|---|
Infliximab | mouse-derived chimeric IgG1; neutralizes both soluble, and membrane-bound TNF-α | Significant, gradual increase [8,10,13,14,15,16,17,18,19,20,21,22,23,24] | Increased BMI promotes drug discontinuation [11,12,26] Failing therapy [12] Steady decrease of PASI-75 with increasing BMI [21] Increased BMI leads to reduced efficacy and delayed response [27] |
Weight-dependent dosing shows to increase efficacy [8,10] |
Etanercept | prototypic recombinant fusion protein; inhibits only soluble TNF-α | Non-uniform [10,19] weight increase [16,17,18,23,24] Non-statistically significant weight increase [10,25] BMI increased more in subjects with normal weight at baseline [19] |
Pharmacokinetic interactions due to wider adipose tissue [10,26] Drug discontinuation [11,12,26] BMI increase affects early clinical response [21] |
Weight-dependent dosing not implemented to date [28]; should be taken in consideration to counteract pharmacokinetic issues Significant weight gain might call for the use of etanercept only in normal BMI individuals [8] |
Adalimumab | phage display-derived, fully monoclonal antibody | Significant mass increase [10,18,19] | Pharmacokinetic interactions due to wider adipose tissue [10,26] Highest drug discontinuation [26] Strong diminished drug efficacy with BMI increase [8] No significant relationship between efficacy and body weight [22] |
Conflicting studies call for further research to draw definitive conclusions |