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The Effect of TNF Inhibition on Bone Density and Fracture Risk and of IL17 Inhibition on Radiographic Progression and Bone Density in Patients with Axial Spondyloarthritis: a Systematic Literature Review

  • Spondyloarthritis (M Khan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Osteoporosis in axial spondyloarthritis may be modified by therapy. The purpose of this systematic review is to describe (i) the effect of TNFi on BMD, (ii) the effect of secukinumab on BMD, and (iii) the effect of secukinumab on radiographic disease progression in axSpA.

Recent Findings

We searched PubMed, Embase, and Cochrane using the following retrieval languages: spondyloarthritis, ankylosing spondylitis, TNF, IL-17, x-rays, and osteoporosis. Twenty-nine studies were included; 27 re: TNFi and BMD, and 2 re: IL-17 blockers and x-ray progression. TNFi over 2–4 years increased BMD of the lumbar spine (3.2–14.9%) and hip (2.26–4.7%) without reducing vertebral fractures. Secukinumab reduced radiographic progression; none (73%) and minimal (79%) at 4 years. No data on IL-17 blockade and bone were found.

Summary

TNFi therapy improves bone density but not vertebral fracture rates. Secukinumab improves symptoms and may slow radiographic progression. Data is lacking regarding the effects of secukinumab on BMD and fractures. These are important questions which may impact the choice of therapy.

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Abbreviations

axSpA:

Axial spondyloarthritis

AS:

Ankylosing spondylitis

TNFi:

Tumor necrosis factor (TNF) inhibitor

RCT:

Randomized control trial

PRISMA:

Preferred reporting items for systematic review and meta-analysis

mSASSS:

Modified Stoke Ankylosing Spondylitis Spinal Score

ACR:

American College of Rheumatology

LS:

Lumbar spine

TH:

Total hip

FN:

Femoral neck

VFx:

Vertebral fractures

OTW:

Occiput to wall

BASFI:

Bath Ankylosing Spondylitis Functional Index

VEs:

Vertebral edges

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

The authors thank Haley Tornberg—research assistant.

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Authors and Affiliations

  1. Department of Rheumatology, Hospital for Special Surgery Hospital for Special Surgery, Weill- Cornell Medical School, 535 East 70th Street, New York, NY, 10021, USA

    Dalit Ashany, Emily M. Stein, Rie Goto & Susan M. Goodman

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  1. Dalit Ashany
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Contributions

DA, EMS, and SMG contributed to the conception and design of the review and assessed all papers, data extraction, and quality assessment. DA, EMG, RG, and SMG performed the literature search. DA drafted the paper; EMS and SMG revised the article for important intellectual content. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Dalit Ashany.

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Conflict of Interest

Dr. Goodman reports grants from Novartis, personal fees from Novartis, personal fees from Pfizer, personal fees from UCB, grants from Horizon, outside the submitted work.

Dr. Ashany reports grants from Novartis, outside the submitted work.

Emily M. Stein and Rie Goto declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Ashany, D., Stein, E.M., Goto, R. et al. The Effect of TNF Inhibition on Bone Density and Fracture Risk and of IL17 Inhibition on Radiographic Progression and Bone Density in Patients with Axial Spondyloarthritis: a Systematic Literature Review. Curr Rheumatol Rep 21, 20 (2019). https://doi.org/10.1007/s11926-019-0818-9

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