The Efficacy of Denosumab in Patients With Rheumatoid Arthritis: A Systematic Review and Pooled Analysis of Randomized or Matched Data.

Qiongwen Hu,Pu Liao,Hua Tian,Xue Zhong

doi:10.3389/fimmu.2021.799575

Qiongwen Hu, Pu Liao + Show 2 more

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https://doi.org/10.3389/fimmu.2021.799575

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Abstract

ObjectiveThe purpose of this study was to evaluate the efficacy of denosumab treatment in patients with rheumatoid arthritis (RA).MethodsThe Medline, Embase and Cochrane Library databases were searched for relevant clinical studies. Studies that assessed the efficacy of denosumab in patients with RA were identified. The primary endpoints were the percent changes in bone mineral density (BMD), and the changes in modified total Sharp score (mTSS), modified Sharp erosion score and joint space narrowing (JSN) score. Pooled analyses were calculated using random-effect models.ResultsAfter searching the literature and performing further detailed assessments, 10 studies with a total of 1758 patients were included in the quantitative analysis. Pooled analyses showed that denosumab treatment significantly increased the percent changes in lumbar spine BMD [mean difference (MD): 5.12, confidence intervals (CI): 4.15 to 6.09], total hip BMD (MD: 2.72, 95% CI: 1.80 to 3.64) and femoral neck BMD (MD: 2.20, 95% CI: 0.94 to 3.46) compared with controls. Moreover, denosumab treatment significantly decreased the changes in mTSS (MD: -0.63, 95% CI: -0.86 to -0.41) and modified Sharp erosion score (MD: -0.62, 95% CI: -0.88 to -0.35). Subgroup analysis indicated that denosumab was superior to bisphosphonates for the improvement of BMD and the mitigation of joint destruction.ConclusionDenosumab treatment was associated with increased BMD and alleviated progression of joint destruction in RA patients, even when compared with bisphosphonates.

Highlights

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation of synovial joints, leading to the progression of joint destruction [1, 2]
Pooled analyses showed that denosumab treatment significantly increased the percent changes in lumbar spine bone mineral density (BMD) [mean difference (MD): 5.12, confidence intervals (CI): 4.15 to 6.09], total hip BMD (MD: 2.72, 95% CI: 1.80 to 3.64) and femoral neck BMD (MD: 2.20, 95% CI: 0.94 to 3.46) compared with controls
Denosumab treatment significantly decreased the changes in modified total Sharp score (mTSS) (MD: -0.63, 95% CI: -0.86 to -0.41) and modified Sharp erosion score (MD: -0.62, 95% CI: -0.88 to -0.35)

Summary

Introduction

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation of synovial joints, leading to the progression of joint destruction [1, 2]. There are various effective pharmacological therapies (such as conventional synthetic and biological disease-modifying anti-rheumatic drugs, DMARDs) that can abate joint inflammation and relieve joint destruction [2, 4], the jointprotective effect of these reagents is not complete. Several initial clinical trials have investigated the effect of denosumab treatment on patients with RA [11,12,13,14]. The study by Kinoshita et al showed that denosumab did not significantly suppress the progression of osteoporosis and the disease activity indices [12]. Takeuchi et al reported that denosumab significantly abated joint destruction and increased bone mineral density (BMD) compared with placebo [13]. The findings of these studies regarding the efficacy of denosumab in RA remain to be further clarified

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Conclusion