Comparative risk of osteoporotic fracture among patients with rheumatoid arthritis receiving TNF inhibitors versus other biologics:​ a cohort study

Shin, A.; Park, E. H.; Dong, Y.-H.; Ha, Y.-J.; Lee, Y. J.; Lee, E. B.; Song, Y. W.; Kang, E. H.

Affiliations

¹Division of Rheumatology Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

²Faculty of Pharmacy School of Pharmaceutical Science, National Yang-Ming University, Taipei, Taiwan

³Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

⁵Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Seoul National University, Seoul, South Korea

Abstract and keywords

Summary: In this population-based cohort study on comparative osteoporotic fracture risks between different biologic disease-modifying drugs among patients with rheumatoid arthritis (RA), we did not find a significant difference in the risk of osteoporotic fractures between RA patients receiving TNF inhibitors versus abatacept or tocilizumab.

Introduction: We aimed to investigate the comparative risk of osteoporotic fractures between rheumatoid arthritis (RA) patients who initiated TNF inhibitors (TNFis) versus abatacept or tocilizumab.

Methods: Using the Korea National Health Insurance Service datasets from 2002 to 2016, RA patients who initiated TNFis, abatacept, or tocilizumab were identified. The primary outcome was a composite end point of non-vertebral fractures and hospitalized vertebral fractures; secondary outcomes were two components of the primary outcome and fractures occurring at the humerus/forearm. Propensity score (PS) matching with a variable ratio up to 10 TNFi initiators per 1 comparator drug initiator was used to adjust for > 50 baseline confounders. We estimated hazard ratios (HRs) and 95% confidence interval (CI) of fractures comparing TNFi initiators to abatacept and to tocilizumab by Cox proportional hazard models stratified by a matching ratio.

Results: After PS-matching, 2307 TNFi initiators PS-matched on 588 abatacept initiators, and 2462 TNFi initiators on 640 tocilizumab initiators were included. A total of 77 fractures occurred during a mean follow-up of 454 days among TNFi and abatacept initiators and 83 fractures during 461 days among TNFi and tocilizumab initiators. The PS-matched HR (95% CI) was 0.91 (0.48–1.71) comparing TNFi versus abatacept initiators, and 1.00 (0.55–1.83) comparing TNFi versus tocilizumab initiators. Analysis on vertebral and non-vertebral fractures showed similar results.

Conclusions: In this nationally representative cohort, we did not find a significant difference in the risk of fractures between TNFi initiators versus abatacept or tocilizumab among RA patients.

Keywords: Biologic disease-modifying drugs; Comparative risk; Fractures; Rheumatoid arthritis

Links

DOI: 10.1007/s00198-020-05488-9

PubMed: 32514765

WoS: 000539283500002

History

Received: 2020-02-21

Accepted: 2020-06-01

Online: 2020-06-08

Cited By (1)

Year

Entry

2023

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