Background Although medication of rheumatoid arthritis (RA) has been improved by early intensive treatment using MTX and biological agents (BIO) for decades, treatment of concomitant disease in RA patients, such as osteoporosis (OP), will be more important to improve activity of daily living of RA patients. We reported two-year outcome of daily teriparatide (TPTD) on OP in RA patients in EULAR 2014 1). TPTD has a strong effect on bone metabolism and increases bone mineral density (BMD). Although prednisolone (PSL) and BIO that are often used in RA patients also have strong effects on bone metabolism, the interaction between TPTD and these drugs have not well-understood.
Objectives This prospective study investigated the impacts of PSL and BIO on the efficacy of TPTD on OP in RA patients.
Methods 50 females with both OP and RA were included in this study. 2 years had passed after the initiation of TPTD. At first, all patients were divided into two groups, which were PSL-concomitant (PG) and Non-PSL-concomitant (NPG). Patients' characteristics, BMD in lumbar spine (LS) and total hip (TH) and change of bone turnover markers (BTMs: BAP, P1NP, NTX, TRACP-5b) were compared between two groups. Next, all patients were divided into two groups, which were BIO-concomitant (BG) and Non-BIO-concomitant (NBG). Change of BMD and BTMs were also compared between two groups.
Results [Baseline patients' characteristics] Mean age was 71.0 years old. Mean RA duration was 19 years. Mean DAS28-CRP and mHAQ were 2.73 and 1.147, respectively. Mean FRAX was 37.4%. [PG (n=35) vs. NPG (n=15)] RA duration in PG was significantly long compared with that in NPG. mHAQ in PG was significantly high compared with that in NPG. Although LS-BMD and TH-BMD in both groups has significantly increased after initiation of TPTD, %increase of BMD in PG tended to be lower than that in NG and there was a significant difference in %increase of TH-BMD at 6 months between in PG and in NPG (-0.5% vs. 3.3%).Dose dependency of PSL in TH-BMD was found. Although BTMs in PG tended to be lower than that in NPG, the differences were not significant. [BG (n=18) vs. NBG (n=32)] Although LS-BMD in BG and NBG and TH-BMD in NBG have significantly increased after the initiation of TPTD, TH-BMD in BG has not. %increases in LS-BMD in BG at 6 months and 18 months were significantly low compared with that in NBG. %increase in TH-BMD in BG at 24 months was significantly low compared with that in NBG. In contrast, % increase of four BTMs in BG was significantly high compared with that in NBG.
Conclusions This study suggested both PSL and BIO modified the effects of TPTD on bone metabolism. %increase of BMD in RA patients taking PSL tended to be low. So, oral PSL should be tapered during TPTD treatment. It was suggested that BIO use decreased the effect of TPTD with respect to %increase in BMD. In contrast, % increase of BTMs in BG was high compared with that in NBG. This is, what is called, the paradoxical response between increase of BMD and BTMs in RA patients treated both BIO and TPTD.
Y. Hirano et al. Efficacy of daily teriparatide for two years on osteoporosis in patients with rheumatoid arthritis – is it appropreate to combine daily teriparatide and biological agents?. Ann Rheum Dis 2014;73(Suppl2).
Disclosure of Interest Y. Hirano Speakers bureau: Eli Lilly Japan Co.Ltd., S. Hirabara: None declared, M. Isono: None declared, Y. Oishi: None declared, T. Kojima Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd., N. Ishiguro Speakers bureau: Abbott Japan Co. Ltd.; Eisai Co. Ltd.; Mitsubishi Tanabe Pharma Corporation; Pfizer Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; and Bristol-Myers Squibb Co. Ltd.