Kobayakawa Tomonori, Kanayama Yasuhide, Hirano Yuji, Yukishima Toshitaka, Nakamura Yukio
Kobayakawa Orthopedic and Rheumatologic Clinic, Fukuroi 437-0061, Shizuoka, Japan.
Department of Orthopedic Surgery and Rheumatology, Toyota Kosei Hospital, Toyota 470-0396, Aichi, Japan.
JBMR Plus. 2024 Oct 23;8(12):ziae131. doi: 10.1093/jbmrpl/ziae131. eCollection 2024 Dec.
This study aimed to evaluate the effectiveness of sequential therapy with a bone formation-promoting agent (either teriparatide or romosozumab) for osteoporosis treatment following prior treatment with the other bone-forming agent (teriparatide or romosozumab). This is a multicenter retrospective cohort study observing 2 groups for comparison: one with 69 patients transitioning from teriparatide to romosozumab (the T2R group) and the other with 25 patients transitioning from romosozumab to teriparatide (the R2T group), monitored for 12 months on the second drug. Key outcomes included changes in bone mineral density (BMD), bone turnover marker changes, and adverse events. The mean ages of each group were 72.3 years in the T2R group and 67.6 years in the R2T group, with the proportions of women being 91.3% and 80.0%, respectively. The percent changes of BMD in the lumbar spine after 12 months of sequential therapy were +10.8% in the T2R group ( < .001 versus baseline) and -0.0% in the R2T group ( = .875). The percent changes in BMD in the total hip and femoral neck were +4.4% and +4.4% in the T2R group, and -1.3% and -0.8% in the R2T group, respectively. When comparing the 2 groups, BMD changes at all sites in the T2R group were significantly higher than those in the R2T group ( < .001). Furthermore, when examining the changes in the proportion of patients who achieved the osteoporosis treatment goal of a T-score exceeding -2.5, no significant increase was observed in the R2T group, whereas a significant increase was observed in the lumbar spine in the T2R group. Regarding therapy switching between bone-forming agents, this study suggests that transitioning from teriparatide to romosozumab increases BMD more effectively than transitioning in the opposite sequence.
本研究旨在评估在先用另一种促骨形成药物（特立帕肽或罗莫单抗）治疗后，序贯使用促骨形成药物（特立帕肽或罗莫单抗）治疗骨质疏松症的有效性。这是一项多中心回顾性队列研究，观察两组进行比较：一组为69例从特立帕肽转换为罗莫单抗的患者（T2R组），另一组为25例从罗莫单抗转换为特立帕肽的患者（R2T组），对第二种药物进行12个月的监测。主要结局包括骨密度（BMD）变化、骨转换标志物变化和不良事件。T2R组的平均年龄为72.3岁，R2T组为67.6岁，女性比例分别为91.3%和80.0%。序贯治疗12个月后，T2R组腰椎BMD的百分比变化为+10.8%（与基线相比， ＜.001），R2T组为-0.0%（ ＝.875）。T2R组全髋和股骨颈BMD的百分比变化分别为+4.4%和+4.4%，R2T组分别为-1.3%和-0.8%。比较两组时，T2R组所有部位的BMD变化均显著高于R2T组（ ＜.001）。此外，在检查达到T值超过-2.5的骨质疏松症治疗目标的患者比例变化时，R2T组未观察到显著增加，而T2R组腰椎观察到显著增加。关于促骨形成药物之间的治疗转换，本研究表明，从特立帕肽转换为罗莫单抗比相反顺序转换更有效地增加BMD。
