Impact of switching oral bisphosphonates to denosumab or daily teriparatide on the progression of radiographic joint destruction in patients with biologic-naïve rheumatoid arthritis
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In biologic-naïve female RA patients, switching oral BPs to DMAb significantly reduced radiographic joint destruction compared to continuing oral BPs or switching to TPTD at 12 months, which were significantly associated with a decrease of a bone resorption marker at 6 months.
The aim of this study was to clarify the effects of switching oral bisphosphonates (BPs) to denosumab (DMAb) or daily teriparatide (TPTD) on the progression of radiographic joint destruction in patients with biologic-naïve rheumatoid arthritis (RA).
A retrospective, case-controlled study involving 90 female RA patients (mean age 68.2 years, 96.7% postmenopausal, disease activity score assessing 28 joints with CRP (DAS28-CRP) 2.4, methotrexate treatment 81.1%, prednisolone treatment 68.9%, and prior BP treatment 44.8 months), who were allocated depending on each patient’s and physician’s wishes, to (1) the BP-continue group (n = 30), (2) the switch-to-DMAb group (n = 30), or (3) the switch-to-TPTD group (n = 30), was conducted. Patients were retrospectively selected to minimize the difference of possible clinical backgrounds that may affect the joint destruction of RA. The primary endpoint was to clarify the change of the modified total Sharp score (mTSS) from baseline to 12 months.
After 12 months, the mean changes of the modified Sharp erosion score were significantly lower in the switch-to-DMAb group (0.2 ± 0.1; mean ± standard error) than in the switch-to-TPTD group (1.3 ± 0.5; P < 0.05), and mTSS was significantly lower in the switch-to-DMAb group (0.3 ± 0.2) than in the BP-continue group (1.0 ± 0.3; P < 0.05) and the switch-to-TPTD group (1.7 ± 0.6; P < 0.05). The logistic regression analysis showed that mTSS changes were significantly associated with the percent changes of TRACP-5b at 6 months (β = 0.30, 95% CI = 0.002–0.016; P < 0.01).
Changes of systemic bone turnover induced by switching BPs to DMAb or TPTD may affect not only systemic bone mass, but also local joint destruction, and its clinical relevance should be considered comprehensively.
KeywordsBisphosphonate Denosumab Joint destruction Rheumatoid arthritis Teriparatide
The authors would like to thank Dr. Masao Yukioka and Dr. Kenrin Shi for their excellent cooperation in conducting the study.
Compliance with ethical standards
Conflicts of interest
K Ebina, M Hirao, J Hashimoto, and H Yoshikawa have received research grants from Astellas Pharma and Eisai Co. Ltd. K Ebina, M Hirao, and H Yoshikawa have received research grants from Daiichi Sankyo. H Yoshikawa has received research grants from MSD. K Ebina has received payments for lectures from Astellas Pharma, Chugai Pharmaceutical, Eisai Co. Ltd., Ono Pharmaceutical, Daiichi Sankyo, and Eli Lily. H Matsuoka, T Iwahashi, R Chijimatsu, Y Etani, G Okamura, and A Miyama declare that they have no conflicts of interest.
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