Background lthough medication of rheumatoid arthritis (RA) has been improved by early intensive treatment using MTX and biological DMARDs 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 efficacy of daily teriparatide (TPTD) on OP in RA patients in EULAR 20141) and EULAR 20152). Although many drugs for OP treatment can be used in clinical practice, information of effect of switching drugs are lacking and needed. Better switching strategy in OP treatment are not well understood.
Objectives This study investigated the efficacy of TPTD after bisphosphonate (BP) treatment in OP of RA patients (RA-OP).
Methods 49 females with RA-OP were included in this study. 2 years had passed after the initiation of TPTD. 32 cases were treated using BP before TPTD (BP-G) and 17 cases were treatment-naïve or treated using only activated-vitamin D3 (N-G). Bone mineral density of lumbar spine (LSBMD) and total hip (THBMD) were measured every 6 month. Bone turnover markers (BTMs) were measured every 6 month (BAP, P1NP, NTX, TRACP-5b). Data were compared between BP-G and N-G.
Results There were no significant differences in most of baseline characteristics between two groups except for CRP value at baseline (0.52mg/dl in BP-G and 0.68mg/dl in N-G).Used BPs were risedronate in 26 cases, alendronate in 4 cases and minodronate in 2 cases. There were no significant differences in LSBMD and THBMD at baseline between 2 groups. Baseline BAP in BP-G were significantly low compared with that in N-G (15.1μg/l vs. 18.6μg/l). Baseline NTX in BP-G were also significantly low compared with that in N-G (15.2 nmolBCE/L vs. 21.6 nmolBCE/L). P1NP and TRACP-5b were comparable between two groups. Mean LSBMD and THBMD in both group were significantly increased during TPTD treatment (Fig1). %increase of LSBMD and THBMD were compared between two groups and there were no significant differences (Fig2). Four BTMs were increased during TPTD treatment in both group. Although there were no significant differences in % increase of BAP, P1NP and TRACP-5b during TPTD treatment, %increase of NTX in BP-G was significantly high compared with that in N-G (84.3% in BP-G and 57.4% in N-G at 6 month).
Conclusions TPTD was effective in not only N-G but also BP-G. Although bone turnover was slightly inhibited and slow in BP-G, TPTD upregulated bone turnover preferably and resulted in increase of BMD in not only N-G but also in BP-G. This study suggested that TPTD was one of options after BP treatment in RA-OP.
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),
Y. Hirano et al. Daily teriparatide treatment for two years on osteoporosis in patients with rheumatoid arthritis – impact of concomitant drugs (prednisolone and biologics) on effects of teriparatide. Ann Rheum Dis 2015; 74(Suppl2).
Disclosure of Interest None declared