Impact of denosumab discontinuation on changes in bone mineral density and bone erosion in rheumatoid arthritis patients
Impact of denosumab discontinuation on changes in bone mineral density and bone erosion in rheumatoid arthritis patients
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DOI：
10.1093/mr/roab022
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发表时间：
2021-11-26
影响因子：
2.2
通讯作者：
Takita, Atsushi
中科院分区：
文献类型：
--
作者：
Tanaka, Sakae;Kobayashi, Makiko;Takita, Atsushi
**目的** 本研究对参与DESIRABLE研究的无骨质疏松症的类风湿关节炎（RA）患者停用狄诺塞麦后骨密度（BMD）和骨侵蚀的变化进行了调查。
**方法** 这项多中心观察性研究包括停药前访视（DESIRABLE最终评估日期）和停药后访视（最后一次使用狄诺塞麦2.5年后）。将腰椎（LS）骨密度较基线的变化百分比作为主要终点进行评估。
**结果** 共纳入59例患者。停药后访视时，腰椎骨密度变化百分比降至基线水平。与基线相比，停用狄诺塞麦后I型胶原C端肽水平升高，但大多数患者的水平仍在参考范围内。治疗期间与停用狄诺塞麦后，骨侵蚀评分无显著差异（p = 0.0666），但停药后数值有所增加。疾病活动处于缓解期的患者与未缓解患者相比，骨侵蚀评分进展显著降低（p = 0.0195）。
**结论** 对于无骨质疏松症的RA患者，在考虑患者背景因素（疾病活动度和骨折风险）并兼顾停药后骨侵蚀进展和腰椎骨密度下降的情况下，可以探索停用狄诺塞麦。
Objectives This study investigated changes in bone mineral density (BMD) and erosion after denosumab discontinuation in rheumatoid arthritis (RA) patients without osteoporosis who participated in the DESIRABLE study. Methods This multicentre observational study consisted of a prediscontinuation visit (date of final assessment in DESIRABLE) and a postdiscontinuation visit (2.5 years after the last administered dose of denosumab). Percentage change in lumbar spine (LS) BMD from baseline was assessed as the primary endpoint. Results Fifty-nine patients were enrolled. The percentage change in LS BMD decreased to baseline levels at the postdiscontinuation visit. Compared with baseline, C-telopeptide of type I collagen levels increased after denosumab discontinuation but most patients had levels within the reference range. Bone erosion scores were not significantly different between the on-treatment period and after denosumab discontinuation (p = .0666) but there was a numerical increase postdiscontinuation. The progression in bone erosion score was significantly reduced in patients whose disease activity was in remission versus those not in remission (p = .0195). Conclusions In RA patients without osteoporosis, denosumab discontinuation can be explored while considering patient background factors (disease activity and risk of fracture) and accounting for progression of bone erosion and LS BMD decrease after withdrawal.