Effect of metabolic surgery on immunosuppressive medication use in patients with rheumatic diseases

Abstract

Background: Obesity is an inflammatory condition associated with higher rheumatic disease (RD) incidence, increased disease activity, and functional impairment.

Objective: We aimed to assess whether metabolic and bariatric surgery (MBS) decreases immunosuppressant use in patients with RD.

Setting: Bariatric surgery academic centers of excellence.

Methods: We conducted a retrospective review of MBS procedures in patients using immunosuppressants for RD between 2008 and 2020 at 2 academic institutions. Patient data were analyzed at 3-, 6-, 12-, and 24-month follow-up intervals. We examined paired differences in the number of preoperative medications relative to different postoperative follow-up periods using McNemar tests for the prednisone-only comparisons and paired t tests for all other comparisons.

Results: We identified 53 patients with RD who underwent MBS (mean age = 53 years; mean follow-up = 19 months). Of these patients, 64% had Roux-en-Y gastric bypass, 30% sleeve gastrectomy, and 6% duodenal switch. Rheumatoid arthritis was the most common RD (42%), followed by psoriasis (19%) and lupus (11%). Mean percent total weight loss and change in body mass index were 31.3% and 15.9 kg/m², respectively, at 24-month follow-up. At 24 months, 10 patients (30%) stopped prednisone (P = .007), and 13 patients (33%) showed a reduction in immunosuppressant use (disease-modifying antirheumatic drugs or glucocorticoids) (P = .01). One patient started glucocorticoids postoperatively, and 2 patients had an increase in immunosuppressant use. At the last encounter, 5 patients were off immunosuppressants, and all medication classes, except biological disease-modifying antirheumatic drugs, showed significant reductions.

Conclusion: There is significant decrease in the use of immunosuppressant agents after MBS in patients with RD. Further studies are needed to confirm the correlation.

Keywords: Bariatric surgery; Immunosuppressants; Rheumatologic diseases.