AB1010 Risk of infection in patients with rheumatoid arthritis taking denosumab concurrent with biologic therapy
Authors: M. Zabihiyeganeh, A.M. Mirzaei, S.A. Jahed
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Apart from Denosumab effects on bone, there are some promising data on its inhibitory effect on structural damagesin patients withRheumatoid Arthritis (RA).<sup>1</sup> Despite some clinical concerns on its potential harm for increasing risk of infections, Denosumab is officially approved for the treatment of postmenopausal osteoporosis. Still there are even greater debates on its use and predisposing patients to infection in cases receiving immunosuppressive therapy.<sup>2</sup> Considering the importance of infection in such cases, lack of sufficient convincing safety data has prevented, at least in part, the current guidelines to recommend Denosumab in treatment of osteoporosis in patients on immunosuppressive agents.<sup>3</sup> <h3>Objectives</h3> We aimed to compare the infection risk in patients with RA taking biologic Disease Modifying Anti Rheumatic Drugs (bDMARDs) alone or concurrent with Denosumab. <h3>Methods</h3> Using records from the files covering January 2013 to May 2016, a retrospective comparative study was performed on two groups of postmenopausal RA patients, group A including 40 patients receiving Denosumab+bDMARDs (Etanercept, Rituximab, Adalimumab), and group B consisting of 44 patients receiving bDMARDs alone. Patients were included if the current therapeutic regimen was used for at least one year. All patients were also on a daily dose of prednisolone (2.5–7.5 mg) and folic acid, and a weekly dose of Methotrexate. Occurrence of serious bacterial or viral infections was extracted from recorded files of the patients' routine visits. <h3>Results</h3> The mean age of the patients was 63.1±12 years and 62.6±11.7 years in group A and B, respectively (p=0.42). The mean disease duration was 7.2±1.9 years and 7.1±1.6 years in group A and B, respectively (p=0.39). The mean duration of biologic use was 15.4±3.2 months and 15.8±4.6 months in group A and B, respectively (p=0.28). Type 2 diabetes mellitus was present in four and five patients of group A and group B, respectively (p=0.35). In total, four infections occurred in our study groups, two in each group (p=0.94). In group A, the first one was an osteomyelitis of the first metatarsal bone in a diabetic patient receiving Etanercept+Denosumab. The second one was a herpes zoster infection in a patient receiving Adalimumab+Denosumab. In group B two cases of herpes zoster were recorded in two patients receiving Adalimumab. <h3>Conclusions</h3> This study showed that the potential infection risk of concurrent use of Denosumab and bDMARDs was not significantly different from using bDMARDs alone. Based on this finding, Denosumab seems safe in the treatment of osteoporosis in RA patients receiving bDMARDs. <h3>References</h3> [1] Hasegawa T, Kaneko Y, Izumi K, Takeuchi T. Efficacy of denosumab combined with bDMARDs on radiographic progression in rheumatoid arthritis. Joint Bone Spine. 2017;84(3):379–80. [2] Miller PD. A review of the efficacy and safety of denosumab in postmenopausal women with osteoporosis. Therapeutic advances in musculoskeletal disease. 2011;3(6):271–82. [3] Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, et al. 2017American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol. 2017;69(8):1521–37. <h3>Disclosure of Interest</h3> None declared