Improvement of bone mineral density and new vertebral fractures during 8 years of TNF-α inhibition in patients with axial spondyloarthritis.

Autor: Siderius M; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands., Wink F; Rheumatology, Medical Center Leeuwarden, the Netherlands., Kieskamp S; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands., Maas F; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands., Bos R; Rheumatology, Medical Center Leeuwarden, the Netherlands., Kroese FGM; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands., Spoorenberg A; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands., Arends S; Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands. Electronic address: s.arends@umcg.nl.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2024 Oct; Vol. 68, pp. 152523. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1016/j.semarthrit.2024.152523
Abstrakt: Objective: In our prospective cohort with standardized bi-annual measurements of bone mineral density (BMD) and spinal radiographs, we evaluated the long-term course of BMD and the development of radiographic vertebral fractures (VFs) during 8 years of TNFi treatment in patients with radiographic axial spondyloarthritis (r-axSpA).
Methods: Consecutive axSpA patients from the GLAS cohort receiving TNFi for ≥8 years were included. Patients who received anti-osteoporotic treatment were excluded. Lumbar spine (LS) BMD was assessed at baseline, 1 year and bi-annually using DEXA. Radiographic VFs were evaluated using the Genant classification.
Results: 126 axSpA patients were included; 75 % male, mean age 42 ± 11 years, ASDAS 3.8 ± 0.8, median LS BMD Z-score -0.5 (IQR -1.4-0.7) and 20 % had radiographic VFs at baseline. Disease activity improved rapidly and sustained. LS BMD Z-score improved significantly up to 4 years compared to the previous time point and sustained thereafter. Median percentage of improvement compared to baseline was 8.9 % (2.8-15.8) and 7.2 % (2.2-14.7) after 4 and 8 years, respectively. Of 90 patients with baseline and 8-year radiographs, 14 (16 %) developed new VFs and 5 (6 %) showed an increase in severity of existing VFs. Of all 44 VFs present at 8 years, 30 % were grade 2 (n = 12) or grade 3 (n = 1).
Conclusion: In r-axSpA patients treated with TNFi for 8 years, LS BMD Z-score increased significantly, especially during the first 4 year of treatment. Radiographic VFs continued to develop or progressed, irrespective of improvement in BMD. Therefore, clinical attention for trabecular bone loss is important in daily clinical practice.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M. Siderius: has received consulting fees from Novartis; F. Wink: has received consulting fees from Novartis and Abbvie; R. Bos has received research grants van Sanofi and Galapagos, and consulting fees from Abbvie, Galapagos, Janssen, Novartis, Pfizer, Sanofi and UCB; A. Spoorenberg: has received research grants from Novartis and consulting fees from Novartis, Abbvie, Pfizer and UCB. The other authors declare that they have no competing interests.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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