Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan.
Osteoporos Int. 2018 Jul;29(7):1627-1636. doi: 10.1007/s00198-018-4492-y. Epub 2018 Mar 24.
In biologic-naïve female RA patients, switching oral BPs to DMAb significantly reduced radiographic joint destruction compared to continuing oral BPs or switching to TPTD at 12 months, which were significantly associated with a decrease of a bone resorption marker at 6 months.
The aim of this study was to clarify the effects of switching oral bisphosphonates (BPs) to denosumab (DMAb) or daily teriparatide (TPTD) on the progression of radiographic joint destruction in patients with biologic-naïve rheumatoid arthritis (RA).
A retrospective, case-controlled study involving 90 female RA patients (mean age 68.2 years, 96.7% postmenopausal, disease activity score assessing 28 joints with CRP (DAS28-CRP) 2.4, methotrexate treatment 81.1%, prednisolone treatment 68.9%, and prior BP treatment 44.8 months), who were allocated depending on each patient's and physician's wishes, to (1) the BP-continue group (n = 30), (2) the switch-to-DMAb group (n = 30), or (3) the switch-to-TPTD group (n = 30), was conducted. Patients were retrospectively selected to minimize the difference of possible clinical backgrounds that may affect the joint destruction of RA. The primary endpoint was to clarify the change of the modified total Sharp score (mTSS) from baseline to 12 months.
After 12 months, the mean changes of the modified Sharp erosion score were significantly lower in the switch-to-DMAb group (0.2 ± 0.1; mean ± standard error) than in the switch-to-TPTD group (1.3 ± 0.5; P < 0.05), and mTSS was significantly lower in the switch-to-DMAb group (0.3 ± 0.2) than in the BP-continue group (1.0 ± 0.3; P < 0.05) and the switch-to-TPTD group (1.7 ± 0.6; P < 0.05). The logistic regression analysis showed that mTSS changes were significantly associated with the percent changes of TRACP-5b at 6 months (β = 0.30, 95% CI = 0.002-0.016; P < 0.01).
Changes of systemic bone turnover induced by switching BPs to DMAb or TPTD may affect not only systemic bone mass, but also local joint destruction, and its clinical relevance should be considered comprehensively.
本研究旨在阐明在初治类风湿关节炎（RA）患者中，将口服双膦酸盐（BP）转换为地舒单抗（DMAb）或每日特立帕肽（TPTD）对放射学关节破坏进展的影响。
这是一项回顾性、病例对照研究，纳入了 90 名女性 RA 患者（平均年龄 68.2 岁，96.7%绝经后，红细胞沉降率和 C 反应蛋白校正的 28 关节疾病活动评分[DAS28-CRP]为 2.4，甲氨蝶呤治疗 81.1%，泼尼松治疗 68.9%，BP 治疗前 44.8 个月），根据每位患者和医生的意愿将其分配至（1）BP 继续组（n=30）、（2）转换至 DMAb 组（n=30）或（3）转换至 TPTD 组（n=30）。选择患者进行回顾性研究，以尽量减少可能影响 RA 关节破坏的临床背景差异。主要终点是明确从基线到 12 个月时改良总 Sharp 评分（mTSS）的变化。
12 个月后，转换至 DMAb 组的改良 Sharp 侵蚀评分平均变化明显低于转换至 TPTD 组（0.2±0.1 比 1.3±0.5；P<0.05），mTSS 也明显低于 BP 继续组（1.0±0.3）和转换至 TPTD 组（1.7±0.6；P<0.05）。逻辑回归分析显示，mTSS 变化与 6 个月时 TRACP-5b 的百分比变化显著相关（β=0.30，95%CI=0.002~0.016；P<0.01）。
BP 转换为 DMAb 或 TPTD 引起的全身骨转换变化不仅可能影响全身骨量，还可能影响局部关节破坏，应综合考虑其临床相关性。
