类风湿关节炎患者使用JAK抑制剂巴瑞替尼治疗期间的骨密度:一项单中心观察性研究

Bone Mineral Density During Treatment with The Janus Kinase Inhibitor Baricitinib in Patients with Rheumatoid Arthritis: A Monocentric Observational Study.

作者信息

Schulz Nils, Asendorf Thomas, van Wijnen Pascal, Wilhelmi Tim, Müller-Ladner Ulf, Lange Uwe, Klemm Philipp

机构信息

Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Justus Liebig University Giessen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Germany.

Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.

出版信息

Calcif Tissue Int. 2025 Jul 22;116(1):101. doi: 10.1007/s00223-025-01410-9.

Abstract

Rheumatoid arthritis (RA) is associated with systemic bone loss and thus an established risk factor for osteoporosis. Janus kinase inhibitors (JAKi) have shown osteo-protective effects. However, clinical data on the effects of baricitinib on bone mineral density (BMD) remain limited. Therefore, we investigated the effects of a 1-year treatment with baricitinib on BMD in RA patients. Patients with active RA beginning treatment with baricitinib were included. BMD was measured at the lumbar spine and femoral neck using Dual-Energy X-Ray Absorptiometry (DXA). Disease activity was assessed using DAS28-CRP and cDAI. The primary endpoint was the change in BMD after 12 months. Secondary endpoints evaluated changes in disease activity, prednisolone dose and alkaline phosphatase (AP) levels and its relation to BMD. A total of 46 RA patients were recruited, of whom 26 completed the study. Overall, BMD remained stable. Non-responders to baricitinib (based on DAS28-CRP) showed a significant decline in spine BMD (- 2.12%, p = 0.039), while responders showed stable BMD. The between-group difference in spine BMD (p = 0.008) and T-score (p = 0.012) was significant. Demographic and clinical characteristics did not differ significantly between groups. Disease activity (DAS28-CRP: p = 0.003; cDAI: p = 0.007), prednisolone dose (p = 0.006), and AP levels (p = 0.03) all improved significantly. Under baricitinib, BMD loss appeared stabilized in RA patients. Non-responders to baricitinib experienced a significant loss of BMD with a significant difference to responders raising the question if seen effects are achieved by controlling disease activity or if there is an additional explicit JAKi effect on bone metabolism. Trial registration number: DRKS00020780, date: 13.3.2020.

摘要

类风湿关节炎(RA)与全身性骨质流失相关,因此是骨质疏松症的既定风险因素。Janus激酶抑制剂(JAKi)已显示出骨保护作用。然而,关于巴瑞替尼对骨密度(BMD)影响的临床数据仍然有限。因此,我们研究了巴瑞替尼1年治疗对RA患者骨密度的影响。纳入开始使用巴瑞替尼治疗的活动性RA患者。使用双能X线吸收法(DXA)测量腰椎和股骨颈的骨密度。使用DAS28-CRP和cDAI评估疾病活动度。主要终点是12个月后骨密度的变化。次要终点评估疾病活动度、泼尼松龙剂量和碱性磷酸酶(AP)水平的变化及其与骨密度的关系。共招募了46例RA患者,其中26例完成了研究。总体而言,骨密度保持稳定。对巴瑞替尼无反应者(基于DAS28-CRP)的脊柱骨密度显著下降(-2.12%,p = 0.039),而有反应者的骨密度保持稳定。脊柱骨密度(p = 0.008)和T值(p = 0.012)的组间差异显著。两组之间的人口统计学和临床特征无显著差异。疾病活动度(DAS28-CRP:p = 0.003;cDAI:p = 0.007)、泼尼松龙剂量(p = 0.006)和AP水平(p = 0.03)均显著改善。在巴瑞替尼治疗下,RA患者的骨密度损失似乎得到稳定。对巴瑞替尼无反应者经历了显著的骨密度损失,与有反应者有显著差异,这引发了一个问题,即观察到的效果是通过控制疾病活动度实现的,还是JAKi对骨代谢有额外的明确作用。试验注册号:DRKS00020780,日期:2020年3月13日。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索