TY - JOUR
T1 - Changes in bone mineral density during long-term treatment with adalimumab in patients with rheumatoid arthritis
T2 - A cohort study
AU - Krieckaert, Charlotte L.M.
AU - Nurmohamed, Michael T.
AU - Wolbink, Gertjan
AU - Lems, Willem F.
N1 - Funding Information: Funding: The clinical part of this study was partially supported by Abbott Laboratories. In addition, this investigation was also facilitated by the Research and Education Division of the Jan van Breemen Research Institute Reade.
PY - 2013/3
Y1 - 2013/3
N2 - Objective. To investigate the effect of long-term adalimumab treatment on BMD of the lumbar spine, total hip and hands in patients with RA. Methods. In 184 established RA patients treated with adalimumab for at least 1 year, BMD measurements of the total hip and lumbar spine were performed using dual-energy X-ray absorptiometry. Metacarpal cortex BMD was measured using digital X-ray radiogrammetry. Results. After 1 year of treatment, BMD of the hip and lumbar spine remained stable, while BMD of the hands decreased significantly by-1.41% (P<0.0001). After a mean follow-up of 4.0 (S.D. 1.0) years, mean BMD change per year was-0.58% and 0.07% for the hip and lumbar spine, respectively (overall P-value of hip was <0.0001 and spine was 0.67). Predictors for BMD loss of the hip were anti-CCP positivity, non-use of bisphosphonates at baseline and BMI. In European League Against Rheumatism (EULAR) non-responders at 52 weeks, BMD change of the hip and spine was-1.25% and 1.08%, respectively, for moderate responders -0.61% and-1.87%, respectively, and in EULAR good responders, BMD remained stable: -0.02% and 0.06%, respectively. BMD of the hands decreased in non-, moderate and good responders (-2.85%, -1.47% and -1.26%, respectively). Conclusion. In patients with severe, established RA, loss of BMD in the spine was arrested over 4 years of adalimumab treatment, whereas BMD of the hands and hip continued to decrease after 1 and 4 years, respectively. The changes in BMD are related to disease activity, underlining the importance of monitoring disease activity.
AB - Objective. To investigate the effect of long-term adalimumab treatment on BMD of the lumbar spine, total hip and hands in patients with RA. Methods. In 184 established RA patients treated with adalimumab for at least 1 year, BMD measurements of the total hip and lumbar spine were performed using dual-energy X-ray absorptiometry. Metacarpal cortex BMD was measured using digital X-ray radiogrammetry. Results. After 1 year of treatment, BMD of the hip and lumbar spine remained stable, while BMD of the hands decreased significantly by-1.41% (P<0.0001). After a mean follow-up of 4.0 (S.D. 1.0) years, mean BMD change per year was-0.58% and 0.07% for the hip and lumbar spine, respectively (overall P-value of hip was <0.0001 and spine was 0.67). Predictors for BMD loss of the hip were anti-CCP positivity, non-use of bisphosphonates at baseline and BMI. In European League Against Rheumatism (EULAR) non-responders at 52 weeks, BMD change of the hip and spine was-1.25% and 1.08%, respectively, for moderate responders -0.61% and-1.87%, respectively, and in EULAR good responders, BMD remained stable: -0.02% and 0.06%, respectively. BMD of the hands decreased in non-, moderate and good responders (-2.85%, -1.47% and -1.26%, respectively). Conclusion. In patients with severe, established RA, loss of BMD in the spine was arrested over 4 years of adalimumab treatment, whereas BMD of the hands and hip continued to decrease after 1 and 4 years, respectively. The changes in BMD are related to disease activity, underlining the importance of monitoring disease activity.
KW - Adalimumab
KW - Osteoporosis
KW - Rheumatoid arthritis
KW - TNF inhibitor
UR - http://www.scopus.com/inward/record.url?scp=84874095703&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/rheumatology/kes320
DO - https://doi.org/10.1093/rheumatology/kes320
M3 - Article
C2 - 23221326
SN - 1462-0324
VL - 52
SP - 547
EP - 553
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 3
ER -