Etanercept Increases Bone Mineral Density in Ankylosing Spondylitis, but Does Not Prevent Vertebral Fractures: Results of a Prospective Observational Cohort Study

Weijden, Maria A. C. van der; Denderen, J.C. van; Lems, Willem F.; Nurmohamed, Michael T.; Dijkmans, Ben A. C.; Horst‐Bruinsma, Irene E. van der

doi:10.3899/jrheum.150857

Cited by 24 publications

(18 citation statements)

References 35 publications

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“…Cytokines released from Th1 and Th2 cells can antagonize each other and inhibit the Th reactions and the release of related factors. The Th1 cytokine IFN-g can antagonize the secretion of Th2 cytokines IL-4 and IL-10, which further inhibits the Th2 reaction (van der Weijden et al, 2016). This study revealed significantly lower levels of serum IL-4 and IL-10 in patients with active AS, who also had higher levels of TNF-a and IFN-g, thereby indicating that imbalance in Th1/Th2 cell numbers might be involved in the pathogenesis of AS.…”

Section: Discussionmentioning

confidence: 59%

Role of Th1/Th2 cytokines in the diagnosis and prognostic evaluation of ankylosing spondylitis

et al. 2017

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Section: Discussionmentioning

confidence: 59%

Role of Th1/Th2 cytokines in the diagnosis and prognostic evaluation of ankylosing spondylitis

et al. 2017

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“…TNFi treatment also shows a positive effect with respect to BMD, both of the hip and lumbar spine . In half of these studies bone formation was confirmed; in the other half no significant changes were found between the patient group and the control group . It should be noted, however, that the effect of TNFi on BMD has only been measured with a maximum follow‐up duration of 3 years.…”

Section: Introductionmentioning

confidence: 95%

“…So far, only two studies have examined the long‐term effect of TNFis on the incidence of VFxs. Van der Weijden and colleagues and Maas et al studied the effect of TNFi treatment on the incidence of VFxs with a subsequent follow‐up duration of 2 and 4 years. From these studies, it can be concluded that despite the treatment with TNFis, the prevalence of VFxs still increased.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Treatment With TNF-Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis

Beek

Rusman

Weijden

et al. 2019

Journal of Bone and Mineral Research

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The aim of this cohort study was to evaluate the long-term effects of TNF inhibitors (TNFis) on BMD and the incidence of vertebral fractures (VFxs) in patients with ankylosing spondylitis (AS). Consecutive patients with active AS with TNFi treatment duration up to 4 years with available DXA scans and spine X-rays were included. BMD (classified according to the WHO criteria for osteoporosis) of the hip and lumbar spine, the VFx (classified as a Genant score !1/!20% height loss), and radiological progression (modified stoke ankylosing spondylitis spinal score [mSASSS]) scores were obtained at baseline and at 4 years of TNFi treatment. Overall, 135 AS patients were included. At baseline, 40.1% of patients had low BMD of the hip and 40.2% of the lumbar spine. This decreased to 38.1% (p ¼ 0.03) with low hip BMD and 25.3% (p < 0.001) of the lumbar spine BMD after 4 years of TNFi treatment. VFxs were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score !2, was found at baseline in 3 out of 14 VFx (21.4%) patients, which increased to 7 out of 27 VFx (25.9%) patients after 4 years. All disease activity parameters-the ankylosing spondylitis disease activity scale, the C-reactive protein, the erythrocyte sedimentation rate, and the bath ankylosing spondylitis disease activity index-decreased significantly (p < 0.001). The mean radiological progression (n ¼ 80) increased significantly from a median mSASSS of 4.0 (1.5 to 16.0) at baseline to 6.5 (2.1 to 22.9) after 4 years of TNFi treatment (p < 0.001). Despite the improvement in BMD and the decrease in disease activity, we still found new VFxs, an increase in severity in the number and grade of VFxs, and radiographic progression during 4 years of treatment with TNFis in AS patients with long disease duration.

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“…Mean BMD change was 5.8% at the spine and 2.3% at the hip in comparison to baseline [41]. Similarly, in a prospective observational study of 49 patients with AS by van der Weijden et al, treatment with etanercept was associated with a significant increase in BMD at the spine and hip at two years (p<0.0001 and p=0.014, respectively) [42]. Despite therapy with etanercept, the number of vertebral fractures more than doubled in two years and fracture severity increased.…”

Section: Treatmentmentioning

confidence: 98%

Osteoporosis Management in Ankylosing Spondylitis

Hinze

Louie

2016

Curr Treat Options in Rheum

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OPINION STATEMENT Low bone mineral density (BMD) is increasingly recognized as a common comorbid condition in ankylosing spondylitis (AS). As low BMD increases fracture risk, it is important to identify and treat low BMD in patients with AS who have been shown to be at increased risk for fractures above the population normal. Since low BMD occurs early in disease, we screen during the first year of diagnosis with dual energy x-ray absorptiometry (DXA). If patients are found to have osteoporosis by T-score of less than −2.5 or if their Z-score on DXA is more than two standard deviations below the mean, we initiate therapy with bisphosphonates in males and in females who are not planning any future pregnancies. While reduction in fracture risk with bisphosphonate therapy has not been clearly defined in patients with AS, reduction in vertebral and hip fractures has been well established in primary osteoporosis and thus it is our first line treatment. If there are contraindications to the use of bisphosphonates in the treatment of low BMD, we will consider the use of denosumab. If the patient is not receiving a TNF-alpha inhibitor (TNFi) and has active disease, we also favor early initiation of TNFi due to their positive effects on BMD though the outcome on reduction in vertebral fractures remains unclear. We counsel all patients regarding the importance of adequate intake of vitamin D and calcium per the Institute of Medicine guidelines. All patients should be encouraged to participate in weight-bearing activities with a focus on core strength and gait training.

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Etanercept Increases Bone Mineral Density in Ankylosing Spondylitis, but Does Not Prevent Vertebral Fractures: Results of a Prospective Observational Cohort Study

Cited by 24 publications

References 35 publications

Role of Th1/Th2 cytokines in the diagnosis and prognostic evaluation of ankylosing spondylitis

Role of Th1/Th2 cytokines in the diagnosis and prognostic evaluation of ankylosing spondylitis

Long-Term Treatment With TNF-Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis

Osteoporosis Management in Ankylosing Spondylitis

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