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THU0121 Low Disease Activity and ACR70-Response Is Associated with The Inhibition of Periarticular Bone Loss in Rheumatoid Arthritis Patients Treated with Certolizumab Pegol plus Methotrexate
  1. A. Pfeil1,
  2. A. Nussbaum1,
  3. C. Jung2,
  4. L. Reinhardt3,
  5. P. Oelzner1,
  6. A. Malich4,
  7. J. Böttcher5,
  8. G. Wolf1
  1. 1Department of Internal Medicine III, Friedrich-Schiller-Univerisity Jena, Jena
  2. 2Department of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Duesseldorf
  3. 3Department of Internal Medicine III, Friedrich -Schiller-University Jena, Jena
  4. 4Institute of Diagnostic Radiology, Suedharz-Hospital Nordhausen, Nordhausen
  5. 5Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany


Background Anti-TNF treatment with certolizumab pegol is an effective therapy in patients with rheumatoid arthritis (RA).

Objectives The aim of this study, based on a post-hoc analysis of the data set used in the RAPID 1 trial (1), focuses on the associations between metacarpal bone mineral density as estimated by Digital X-ray Radiogrammetry and disease activity as well as ACR70-Response in RA patients treated with certolizumab pegol plus methotrexate (CZP+MTX).

Methods The post-hoc analysis of the RAPID 1 trial evaluates a total of 345 patients: 34 patients who received placebo plus methotrexate (PBO+MTX), 155 patients who received CZP 200 mg (every two weeks) plus MTX and 156 patients who received CZP 400 mg (every two weeks) plus MTX. All patients underwent x-rays of the hand at baseline and week 52 as well as computerized calculations of bone mineral density (BMD) by DXR (2). ACR70-response was evaluated.

Results The highest CRP reduction was observed for patients treated with CZP 400 mg + MTX (-63.6%, p<0.05) and CZP 200 mg + MTX (-55.9%, p<0.05) compared to the PBO+MTX (-24.7%, p<0.05). An equal constellation was revealed regarding the DAS28-CRP (CZP 400 mg + MTX: -50.5%, p<0.05; CZP 200 mg + MTX: -49.3%, p<0.05 and PBO + MTX: -31.3%, p<0.05). In accordance with these results, DXR-BMD showed a minor significant bone loss for the treatment groups undergoing therapy with CZP 400 mg + MTX and CZP 200 mg + MTX with -1.1% (p<0.05) versus -1.3% (p<0.05), and an advanced periarticular metacarpal bone loss of -5.5% (p<0.05) in the PBO+MTX. The patients treated in the small PBO+MTX group revealed no significant ACR70-Response. Both CZP+MTX groups revealed a significant ACR70-Response. In the case of ACR70-Response no significant change of the DXR-BMD was observed.

Conclusions The study highlights that patients treated with CZP+MTX showed a high reduction of CRP and DAS28-CRP in association to a less accentuated periarticular bone loss as estimated by DXR in comparison to patients treated with PBO+MTX. Additionally, patients with ACR70-Response revealed no periarticular demineralisation. The reduced periarticular demineralization functions as a surrogate marker for the bone protective effects of certolizumab pegol.

  1. Keystone E, Heijde Dv, Mason D Jr, et al. Certolizumab pegol plus methotrexate is significantly more effective than placebo plus methotrexate in active rheumatoid arthritis: findings of a fifty-two-week, phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 2008;58:3319–29.

  2. Pfeil A, Haugeberg G, Hansch A, et al. Value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011;63:666–74.

Disclosure of Interest None declared

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