Investigating the Effects of DMARDs on Sarcopenia

Sarcopenia is a common comorbidity in patients with rheumatoid arthritis (RA) involving muscle mass and quality impairment; However, according to Thales Hein and colleagues, the effect of disease-modifying anti-rheumatic drugs (DMARDs) on sarcopenia is unclear. They conducted a meta-analysis of randomized clinical trials and concluded that there was no evidence of a meaningful effect of DMARD therapy on skeletal muscle tissue in patients with RA.

The authors’ systematic review identified 9 studies published to the Medline, Embase, Cochrane Library, and Web of Science databases. The included studies enrolled patients with RA treated with DMARDs and reported on muscle mass parameters including lean mass and appendicular lean mass. Study quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale.

DMARDs Don’t Appear to Improve Muscle Mass or Quality in Rheumatoid Arthritis

Among the 9 studies, sample sizes ranged from 8 to 146, and participants’ mean years of age ranged from 50 to 61. Baseline Disease Activity Score-28 for rheumatoid arthritis ranged from 3.0 to 6.1. Interventions included tocilizumab, anti-tumor necrosis factor inhibitors, Janus kinase inhibitors, rituximab, biological DMARDS, etanercept, methotrexate, sulfasalazine, and hydroxychloroquine.

Reportedly, in general analysis, DMARD therapy was not shown to increase muscle lean mass in patients (mean, 0.47; 95% CI, -0.92 to 1.87; I2=0%; P=.91), nor did DMARD therapy increase mean appendicular lean mass delta (mean, 1.11; 95% CI, -0.58 to 2.79; I2=0%; P=.91). Additionally, tocilizumab and anti-tumor necrosis factor inhibitor treatment had positive means, while rituximab and biologic DMARDs had negative means.

While their analysis did not support any effect of DMARDs on muscle mass in patients with rheumatoid arthritis and comorbid sarcopenia, the authors acknowledged that the limitations of their review may have obscured a potential benefit.

They further suggested that “the enlightenment of how DMARDs act in muscle mass is important for the formulation of treatment protocols that can treat not only autoimmune and inflammatory diseases but also muscle-wasting conditions such as sarcopenia and cachexia.”

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