Treatment with the TNF-α inhibitor adalimumab (Humira) for four years appears to arrest spinal bone loss in some rheumatoid arthritis (RA) patients, according to a new study from the Netherlands.
The study of 184 patients with severe, established RA finds those treated with adalimumab had stable BMD in the lumbar spine and hip after just one year, but a significant decline in BMD in the hands. After four years, the mean change in BMD was -0.58% in the hips (a significant response) and 0.07% in the spine, as measured with dual x-ray absorptiometry.
Predictors of BMD loss in the hip include positivity for anti-citrullinated peptide antibodies (anti-CCP), non-use of bisphosphonates at baseline, and body mass density.
Judging response to the drug by European League Against Rheumatism (EULAR) standards at 52 weeks, BMD changes in the spine and hip correlated approximately with the degree of response. In contrast, BMD in the metacarpal cortex as detected by digital x-ray radiogrammetry continued to decrease at all levels of drug response.
The researchers stress the importance of monitoring for bone loss in these patients because decline in BMD is related to disease activity.