Yang Jiwon, Park Youngjae, Lee Jennifer Jooha, Kwok Seung-Ki, Ju Ji Hyeon, Kim Wan-Uk, Park Sung-Hwan
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
Ther Adv Musculoskelet Dis. 2025 Jan 28;17:1759720X251314712. doi: 10.1177/1759720X251314712. eCollection 2025.
Rheumatoid arthritis (RA) and prolonged high-dose glucocorticoid (GC) treatment are established risk factors for osteoporosis.
In this study, we aimed to evaluate the therapeutic efficacy of denosumab according to the GC dose considered to increase the risk of glucocorticoid-induced osteoporosis (GIOP) in patients with RA.
A retrospective analysis of collected data on RA patients with osteoporosis starting denosumab.
We included 418 patients with RA who were started on denosumab therapy and categorized them into those with and without GC intake ⩾2.5 mg/day for >3 months. The -score and areal bone mineral density (aBMD) at the lumbar spine, total hip, and femur neck, as well as serum bone turnover markers, were measured at baseline and 12 months. We performed between-group and within-group comparisons of the BMD values at baseline and at 12 months.
Denosumab significantly increased the -scores and aBMD at the lumbar spine, total hip, and femur neck after 12 months, regardless of GC intake. However, apart from the -score at the lumbar spine, the other parameters did not show significant between-group differences. Similarly, in patients with anti-cyclic citrullinated peptide (CCP) antibody positivity or those treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs), although there were significant increases in the -score and areal BMD at all sites in both groups, there were no significant between-group differences.
Our findings suggest that the GC dose considered to increase the risk of GIOP did not significantly attenuate the therapeutic efficacy of denosumab in RA patients, including those positive for anti-CCP antibodies and users of biologic or targeted synthetic DMARDs.
类风湿关节炎（RA）和长期大剂量糖皮质激素（GC）治疗是公认的骨质疏松症危险因素。
在本研究中，我们旨在根据被认为会增加糖皮质激素诱导的骨质疏松症（GIOP）风险的GC剂量，评估地诺单抗在RA患者中的治疗效果。
对开始使用地诺单抗治疗的RA骨质疏松症患者收集的数据进行回顾性分析。
我们纳入了418例开始接受地诺单抗治疗的RA患者，并将他们分为GC摄入量≥2.5mg/天且持续超过3个月和未超过3个月的两组。在基线和12个月时测量腰椎、全髋和股骨颈的T值和面积骨密度（aBMD），以及血清骨转换标志物。我们对基线和12个月时两组之间以及组内的BMD值进行了比较。
无论GC摄入量如何，地诺单抗在12个月后均显著提高了腰椎、全髋和股骨颈的T值和aBMD。然而，除腰椎T值外，其他参数在两组之间未显示出显著差异。同样，在抗环瓜氨酸肽（CCP）抗体阳性的患者或接受生物或靶向合成改善病情抗风湿药物（DMARDs）治疗的患者中，尽管两组所有部位的T值和面积骨密度均显著增加，但两组之间无显著差异。
我们的研究结果表明，被认为会增加GIOP风险的GC剂量并未显著削弱地诺单抗在RA患者中的治疗效果，包括抗CCP抗体阳性的患者以及生物或靶向合成DMARDs使用者。
