Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study - 16/06/22

Doi : 10.1016/j.amjmed.2022.01.017

Shahab Abtahi, MD, PhD ^a,^b,^c, René Cordtz, MD, PhD ^d,^e, Lene Dreyer, MD, PhD ^d,^f, Johanna H M Driessen, PhD ^a,^b,^c,^g, Annelies Boonen, MD, PhD ^h,ⁱ, Andrea M Burden, PhD ^a,^j,^⁎
^a Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands
^b Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
^c Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
^d Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
^e Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
^f DANBIO – The Danish Rheumatologic Database, Copenhagen, Denmark
^g NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
^h Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
ⁱ Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
^j Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland

^⁎Requests for reprints should be addressed to Andrea M. Burden, PhD, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, HCI H 407, Vladimir-Prelog-Weg 4/10, CH-8093, Zurich, Switzerland.Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichHCI H 407, Vladimir-Prelog-Weg 4/10ZurichCH-8093Switzerland

Abstract

Objectives

Clinical trials have shown a beneficial effect from biological disease-modifying antirheumatic drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis; however, it is unclear if this translates to a reduced fracture risk. We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in rheumatoid arthritis.

Methods

A cohort of patients with rheumatoid arthritis aged 18+ from DANBIO was linked to population-based health registries in Denmark (2006-2016). Adopting a prevalent new-user design, we matched bDMARD users to bDMARD-naïve patients using time-conditional propensity scores. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, and forearm) was estimated among the matched patients by Cox proportional hazards models.

Results

Out of 24,678 patients with rheumatoid arthritis, 4265 bDMARD users were matched to the same number of bDMARD-naïve patients (mean age 56.2 years, 74% female). During follow-up, 229 osteoporotic fractures occurred among bDMARD users and 205 fractures among bDMARD-naïve patients (incidence rates 12.1 and 13.0 per 1000 person-years, respectively). The use of bDMARDs was not associated with a reduced risk of osteoporotic fractures among patients with rheumatoid arthritis (hazard ratio 0.97, 95% confidence interval 0.78-1.20), compared with no biological treatment. The risk estimates were similar for all osteoporotic fracture sites.

Conclusion

We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with rheumatoid arthritis.

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Keywords : Biological products, Disease-modifying antirheumatic drugs, Osteoporotic fractures, Rheumatoid arthritis

Plan

Introduction

Methods

Data Source

Study Population and Design

Exposure and Outcome

Matching and Covariate Selection

	Funding: None.
	Conflicts of Interest: SA, RC, JHMD report none. LD reports receiving grants/research support from BMS, honoraria from Eli Lilly, and support for attending meetings from UCB, Abvie, and Boehringer Engelheim. AB reports receiving research grants from Abbvie and honoraria for advisory boards from Abbvie and Galapagos. AMB is partially endowed by the ETH Foundation and the Swiss National Pharmacists Association (PharmaSuisse).
	Authorship: All authors had access to the data and a role in writing this manuscript.

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Vol 135 - N° 7

P. 879 - juillet 2022 Retour au numéro

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Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study - 16/06/22

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