Different Effects of Biologics on Systemic Bone Loss Protection in Rheumatoid Arthritis: An Interim Analysis of a Three-Year Longitudinal Cohort Study.

Ming-Han Chen,Chang-Youh Tsai,Chung-Yuan Hsu,Wei-Sheng Chen,Ying-Chou Chen,Shan-Fu Yu,Jia-Feng Chen,Tien-Tsai Cheng,The-Ling Liou,Chung-Tei Chou,Han-Ming Lai

doi:10.3389/fimmu.2021.783030

Abstract

ObjectiveTo compare changes in bone mineral density (BMD) in rheumatoid arthritis (RA) patients receiving three-year conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD), tumor necrosis factor-α inhibitors (TNFi), and abatacept.MethodsPatients with RA were recruited from September 2014 to February 2021. Dual-energy X-ray absorptiometry was used to measure BMD at the femoral neck (FN), total hip (TH), and lumbar spine (L1-4) at enrollment and three years later. Changes in the BMD of each regimen group were analyzed. Multiple ordinary least squares regression was used with the dependent variables to develop a model to predict the change in BMD.ResultsA total of 752 participants were enrolled and 485 completed the three-year follow-up period. Of these, 375 (Group I), 84 (Group II), and 26 (Group III) participants received csDMARDs, TNFi, and abatacept therapy, respectively. Considering both type of therapy and completion of the follow-up period, participants were divided into groups A (csDMARDs, n = 104), B (TNFi, n = 52), and C (abatacept, n = 26). Compared to baseline, BMD decreased significantly at FN (p = 0.003) and L1-4 (p = 0.002) in Group A and at L1-4 (p = 0.005) in Group B, but remained stable at all sites in Group C. In terms of regression-adjusted percent change in BMD, there was a significant difference seen at all measured sites between group C compared to both groups A and B (+0.8%, -2.7%, -1.8% at FN; +0.5%, -1.1%, -1.0% at TH; +0.8%, -2.0%, -3.5% at L1-4, respectively; all p < 0.05). Anti-osteoporosis therapy had a BMD-preserving effect in RA.ConclusionCompared with csDMARDs and TNFi, abatacept may have a better BMD-preserving effect in RA. Anti-osteoporosis therapy can prevent systemic bone loss irrespective of RA therapy.

Highlights

Rheumatoid arthritis (RA) is one of the most common forms of chronic inflammatory arthritis
375 (Group I), 84 (Group II), and 26 (Group III) participants received conventional synthetic disease-modifying antirheumatic drugs (csDMARD), tumor necrosis factor-a inhibitors (TNFi), and abatacept therapy, respectively. Considering both type of therapy and completion of the follow-up period, participants were divided into groups A, B (TNFi, n = 52), and C
In terms of regression-adjusted percent change in bone mineral density (BMD), there was a significant difference seen at all measured sites between group C compared to both groups A and B (+0.8%, -2.7%, -1.8% at femoral neck (FN); +0.5%, -1.1%, -1.0% at total hip (TH); +0.8%, -2.0%, -3.5% at L1-4, respectively; all p < 0.05)

Summary

Introduction

Rheumatoid arthritis (RA) is one of the most common forms of chronic inflammatory arthritis. This symmetrical polyarthritis mainly affects middle-aged females and leads to progressive joint destruction and loss of function [1]. Osteoporosis is characterized by low bone mass, leading to bone fragility as well as a consequent increase in fracture risk [2]. It is well known that patients with RA have an increased risk of developing osteoporosis. Compared with the general population, a two-fold increase in the frequency of osteoporosis in the spine was observed in RA patients [4]. A meta-analysis revealed that the relative risk for bone fracture was higher among patients with RA than among those without RA (risk ratio 2.25) [5]

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Conclusion