Impact of TNF-a inhibitors on body weight and BMI: A Systematic Review and Meta-Analysis

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Objective: The aim of this systematic review and meta-analysis of longitudinal studies was to ascertain to effects of TNF-a inhibitor therapy on body weight and BMI. Methods: Three databases (PubMed, OVID, and EMBASE) were systematically searched from inception to August 2018. We identified prospective, retrospective, and randomized controlled studies in adults with immune-mediated inflammatory diseases treated with TNF-a inhibitors based on pre-specified inclusion criteria. A random-effects model was used to estimate standardised mean change (SMCC). Results: Twenty-six longitudinal studies with a total of 1,245 participants were included in the meta-analysis. We found evidence for a small increase in body weight (SMCC=0.24, p=.0006, 95% CI [0.10, 0.37]) and in BMI (SMCC=0.26, p <.0001, 95% CI [0.13, 0.39]). On average, patients gained 0.90kg (SD=5.13) under infliximab, 2.34kg (D=5.65) under etanercept and 2.27kg (SD=4.69) during treatment with adalimumab within the duration of the respective studies (4-104 weeks). Conclusion: Our results yield further support the for the view that TNF-a inhibitors increase body weight and BMI as a potential side effect. Modulating cytokine signaling could be a future therapeutic mechanism to treat disorders associated with weight changes such as anorexia nervosa.

Original languageEnglish
Article number481
JournalFrontiers in Pharmacology
Publication statusPublished - 15 Apr 2020


  • TNF-alpha
  • BMI
  • weight change
  • cytokines
  • Anorexia nervosa
  • adalimumab
  • Infliximab
  • Etanercept


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