Body weight affects how children respond to multiple sclerosis treatment, according to a study published in JAMA Neurology. Children who have a healthy body weight are more likely to respond better to first-line treatments with interferon beta and glatiramer acetate. In addition, the switch rate to a second-line disease-modifying therapy—Gilenya (fingolimod), Tysabri (natalizumab), Lemtrada (alemtuzumab), or Rituxan (rituximab)—was about 50% higher for overweight and obese pediatric MS patients.
The findings do not indicate that obesity itself promotes greater disease activity. Instead, pharmacokinetic factors affecting how the drugs are metabolized seem to be at play. It’s very likely that a healthy weight will improve outcomes while reducing costs, wrote Brenda Huppke, MD, and her colleagues with the University Medical Center Gottingen in Germany.
Their study looked at 453 patients with relapsing-remitting pediatric MS who underwent treatment at the center. One hundred twenty-six of the patients (27.8%) were overweight or obese at diagnosis. BMI measurements were taken within six months of diagnosis. Patients who were obese at diagnosis experienced nearly twice as many relapses while being treated compared with nonoverweight patients.
“Studying the association of obesity with the pharmacokinetics of first-line DMTs may improve the understanding of treatment response in obese patients and possibly even enable the development of BMI-adjusted dosing recommendations,” noted Huppke and her coauthors.