生物制剂对类风湿关节炎患者系统性骨丢失保护的不同影响：一项为期三年的纵向队列研究的中期分析。

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

机构信息

Division of Allergy- Immunology- Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

出版信息

Front Immunol. 2021 Dec 20;12:783030. doi: 10.3389/fimmu.2021.783030. eCollection 2021.

DOI:10.3389/fimmu.2021.783030

PMID:34987510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8720866/

Abstract

OBJECTIVE

To 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.

METHODS

Patients 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.

RESULTS

A 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.

CONCLUSION

Compared 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.

摘要

目的

比较类风湿关节炎（RA）患者接受三年常规合成改善病情抗风湿药物（csDMARDs）、肿瘤坏死因子-α抑制剂（TNFi）和阿巴西普治疗后骨密度（BMD）的变化。

方法

2014 年 9 月至 2021 年 2 月招募 RA 患者。在入组时和三年后使用双能 X 射线吸收法测量股骨颈（FN）、全髋关节（TH）和腰椎（L1-4）的 BMD。分析每个方案组的 BMD 变化。使用多元普通最小二乘法回归对因变量进行建模，以预测 BMD 的变化。

结果

共纳入 752 名患者，其中 485 名完成了三年的随访。其中，375 名（I 组）、84 名（II 组）和 26 名（III 组）患者分别接受了 csDMARDs、TNFi 和阿巴西普治疗。考虑到治疗类型和随访完成情况，将患者分为 A 组（csDMARDs，n=104）、B 组（TNFi，n=52）和 C 组（阿巴西普，n=26）。与基线相比，A 组 FN（p=0.003）和 L1-4（p=0.002）处 BMD 显著下降，B 组 L1-4 处（p=0.005）BMD 下降，但 C 组所有部位 BMD 稳定。在经过回归调整的 BMD 百分比变化方面，与 A 组和 B 组相比，C 组在所有测量部位均有显著差异（FN 处+0.8%、-2.7%、-1.8%；TH 处+0.5%、-1.1%、-1.0%；L1-4 处+0.8%、-2.0%、-3.5%；均 p<0.05）。抗骨质疏松治疗对 RA 有维持 BMD 的作用。