CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Adalimumab therapy reduces hand bone loss in early rheumatoid arthritis: explorative analyses from the PREMIER study

M Hoff^1,2, T K Kvien^3,4, J Kälvesten⁵, A Elden⁶, G Haugeberg^2,7

¹ Department of Rheumatology, St Olav’s Hospital, Trondheim, Norway
² Norwegian University of Science and Technology, Trondheim, Norway
³ Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
⁴ Faculty of Medicine, University of Oslo, Oslo, Norway
⁵ Sectra, Linköping, Sweden
⁶ Abbott Laboratories, Oslo, Norway
⁷ Department of Rheumatology, Sørlandet Hospital, Kristiansand S, Norway

Dr M Hoff, University Hospital of Trondheim, Norwegian University of Science and Technology, MTFS, Department of Neuroscience, Division of Rheumatology, NO-7489 Trondheim, Norway; mari.hoff{at}ntnu.no

Objective: The effect of adalimumab on hand osteoporosis was examined and related to radiographic joint damage in the three treatment arms of the PREMIER study: adalimumab plus methotrexate, adalimumab and methotrexate monotherapy. Predictors of hand bone loss were also searched for.

Methods: 768 patients (537 fulfilled 2 years) with rheumatoid arthritis (RA) for less than 3 years, never treated with methotrexate, were included. Hand bone loss was assessed by digital x ray radiogrammetry (DXR) on the same hand radiographs scored with modified Sharp score at baseline, 26, 52 and 104 weeks. For DXR, metacarpal cortical index (MCI) was the primary bone measure.

Results: At all time points the rate of percentage DXR–MCI loss was lowest in the combination group (–1.15; –2.16; –3.03) and greatest in the methotrexate monotherapy group (–1.42; –2.87; –4.62), with figures in between for the adalimumab monotherapy group (–1.33; –2.45; –4.03). Significant differences between the combination group and the methotrexate group were seen at 52 (p = 0.009) and 104 weeks (p<0.001). The order of hand bone loss across the three treatment arms was similar to the order of radiographic progression. Older age, elevated C-reactive protein and non-use of adalimumab were predictors of hand bone loss.

Conclusion: This study supports a similar pathogenic mechanism for hand bone loss and erosions in RA. The combination of adalimumab and methotrexate seems to arrest hand bone loss less effectively than radiographic joint damage. Quantitative measures of osteoporosis may thus be a more sensitive tool for assessment of inflammatory bone involvement in RA.

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• Haugeberg, G, Conaghan, P G, Quinn, M, Emery, P (2009). Bone loss in patients with active early rheumatoid arthritis: infliximab and methotrexate compared with methotrexate treatment alone. Explorative analysis from a 12-month randomised, double-blind, placebo-controlled study. Ann Rheum Dis 68: 1898-1901 [Abstract] [Full Text]