AB0443 The effects of denosumab for rheumatoid arthritis patient
Authors: I. Yoshii
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Denosumab (dMAB), an anti-receptor activator of nuclear factor kappa-B ligand (RANKL) monoclonal antibody, is now popular anti bone absorption suppressant for osteoporosis. Recently, this drug has indicated for rheumatoid arthritis (RA) treatment, for expectance for suppressant in joint destruction. However, except of the effect on joint deformation, anti inflammation effect is not evident in randomised control trial (RCT), although rich case series for OP in RA patient is already collected in clinical practice. <h3>Objectives</h3> Aim of this study is to investigate effects of dMAB on RA, and evaluate other effects but joint destruction suppression. <h3>Methods</h3> In 352 patients who have been treated with dMAB, RA patients who have been treated with dMAB consecutively for more than 1 year, were picked up for this study. Patient who have had experience of biologic disease modifying anti rheumatic drug (bDMARD) or targeted synthetic DMARD, had been eliminated. In whom bone mineral density (BMD) in lumbar spine (LS), femoral neck (FN), and greater trochanter (GT), and tartrate-resistant acid phosphatase 5b (TRACP5b), 28-joints disease activity score with C-reactive protein (DAS28-CRP), Health Assessment Questionnaire Disease Index (HAQ-DI), yearly progression of Sharp/van der Heijde score (dSHS), joint space narrowing score (dJSN) and bone erosion score (dBE), and pain score with visual analogue scale (PS-VAS) were measured, and their mean values were compared between 6 months before start (BEF) and 6 months after start (AFT) statistically with paired T-test. Statistically significant level was set less than 1%. <h3>Results</h3> One hundred and three patients, in whom 100 were female and three were male, were donated in this study. All of them had been supplemented with Denotas Chewable Combination Tablets (Daiichi Sankyo Co., Ltd; Tokyo, Japan), which is medical compound with calcium and natural vitamin D<sub>3</sub>. Average age at start was 71.17 years old, and disease duration of RA at start was 7.42 years. Glucocorticoid was administered in 45 patients (44.7%), and methotrexate was administered in 72 patients (69.9%). BMD demonstrated from 74.03 (%YAM) to 77.32 in LS, whereas from 69.79 to 69.63 in FN, and from 71.99 to 74.27 in GT, from BEF to AFT, respectively. BMD of LS and GT at AFT demonstrated significant increase, while FN demonstrated no significant difference. TRACP5b demonstrated 489.3 at BEF, while 255.3 at AFT. TRACP5b at AFT demonstrated significant less value than at BEF. Disease activity, namely DAS28-CRP, tenderness joint count (TJC), swollen joint count (SJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), CRP, pain score with visual analogue scale (PS-VAS), HAQ-DI, SHS, JSN, and BE from BEF to AFT demonstrated 2.12 to 1.86, 1.32 to 0.89, 2.13 to 0.97, 2.23 to 2.01, 1.27 to 0.68, 0.80 to 0.70, 0.537 to 0.590, 81.76 to 80.98, 36.16 to 37.08, 46.96 to 44.27, respectively. DAS28-CRP, and all of its components, and EGA demonstrated significant decrease, although PS-VAS showed decrease yet demonstrated no significance, while HAQ-DI showed increase with no statistical significance. dSHS and dBE demonstrated significant less at AFT than at BEF, while no significance for dJSN yet slightly increased in the AFT, even no significant difference demonstrated for absolute values (table 1). <h3>Conclusions</h3> The effect of dMAB on RA is suggested suppression of dBE, BMD increase in LS and GT, improvement of DAS28-CRP, and may have decrease of PS-VAS. <h3>Disclosure of Interest</h3> None declared