Zoledronate for prevention of bone erosion in tophaceous gout: a randomised, double-blind, placebo-controlled trial
| Autor: | Ashika Chhana, Meaghan E House, Ian R. Reid, Nicola Dalbeth, Fiona M McQueen, Gregory D. Gamble, Mark Roger, Opetaia Aati, Anthony Doyle, Anne Horne |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty Gout Immunology Osteoporosis Placebo-controlled study Placebo Zoledronic Acid General Biochemistry Genetics and Molecular Biology Bone remodeling Double-Blind Method Rheumatology Bone Density Internal medicine Clinical endpoint Humans Immunology and Allergy Medicine Femur Bone Resorption Aged Bone mineral Bone Density Conservation Agents Diphosphonates business.industry Foot Bones Imidazoles Middle Aged medicine.disease Spine Surgery Treatment Outcome Female Tomography X-Ray Computed business |
| Zdroj: | Annals of the Rheumatic Diseases. 73:1044-1051 |
| ISSN: | 1468-2060 0003-4967 |
| DOI: | 10.1136/annrheumdis-2013-205036 |
| Popis: | Objectives The osteoclast has been implicated in development of bone erosion in gout. The aim of this study was to determine whether zoledronate, a potent antiosteoclast drug, influences bone erosion in people with tophaceous gout. Methods This was a 2-year, randomised, double-blind, placebo-controlled trial of 100 people with tophaceous gout. Participants were randomised to annual administration of 5 mg intravenous zoledronate or placebo. The primary endpoint was change in the foot CT bone erosion score from baseline. Secondary endpoint was change in plain radiographic damage scores. Other endpoints were change in bone mineral density (BMD), bone turnover markers and the OMERACT-endorsed core domains for chronic gout studies. Results There was no change in CT erosion scores over 2 years, and no difference between the two treatment groups at Year 1 or 2 (p (treat) =0.10, p (time) =0.47, p (treat*time) =0.23). Similarly, there was no change in plain radiographic scores over 2 years, and no difference between the two groups at Year 1 or 2. By contrast, zoledronate increased spine, neck of femur, total hip and total body BMD. Zoledronate therapy also reduced the bone turnover markers P1NP and β-CTX compared with placebo. There was no difference between treatment groups in OMERACT-endorsed core domains. Conclusions Despite improvements in BMD and suppression of bone turnover markers, antiosteoclast therapy with zoledronate did not influence bone erosion in people with tophaceous gout. These findings suggest a disconnect between responses in the healthy skeleton and at sites of focal bone erosion in tophaceous gout. |
| Databáze: | OpenAIRE |
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