POS0116 IMPACT OF GLUCOCORTICOIDS ON THE THERAPEUTIC EFFICACY OF DENOSUMAB IN OSTEOPOROSIS OF RHEUMATOID ARTHRITIS PATIENTS
Authors: S. H. Park, J. Yang, Y. Park, J. Lee, S. K. Kwok, J. H. Ju, W. U. Kim
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a major inflammatory disease and is recognized as a prominent factor contributing to secondary osteoporosis. Additionally, glucocorticoids (GC) are commonly used as therapeutic agents for autoimmune diseases including RA, however, prolonged high-dose GC intake also leads to a decrease in bone mineral density (BMD) and an increased risk of fractures. <h3>Objectives:</h3> In this study, we aimed to compare the therapeutic efficacy of denosumab based on the GC dose considered to induce glucocorticoid-induced osteoporosis (GIOP), in patients with RA. <h3>Methods:</h3> 418 RA patients who visited Seoul St. Mary's Hospital and administered denosumab (60 mg subcutaneously once every 6 months for 12 months) between January 2016 and December 2023 were included. T-score and areal bone mineral density (aBMD) at the lumbar spine, total hip, and femur neck were measured at baseline and 12 months. The patients were categorized into two groups based on GC intake ≥2.5 mg/day for &gt;3 months during the period. Comparative analyses were conducted to assess the baseline and 12 months T-score differences and aBMD changes between the two groups, and T-score and aBMD at baseline and 12 months within each group. Subgroup analyses based on anti-cyclic citrullinated peptide (CCP) antibody positivity, which considered to be a risk factor for radiographic damage, were also performed. <h3>Results:</h3> Both in the RA patients received GIOP dose of GC or not, denosumab showed a significant increase in T-scores and aBMD at the lumbar spine, total hip, and femur neck after 12 months compared to baseline. However, the increase in lumbar spine T-score was significantly lower in the GIOP dose of GC group compared to the group without GIOP dose of GC. In patients positive for anti-CCP antibodies, a significant improvement in T-scores and aBMD at the lumbar spine, total hip, and femur neck after 12 months compared to baseline after denosumab administration was also observed, regardless of GIOP dose of GC intake. No significant differences were observed in the degree of improvement between the two groups. In patients negative for anti-CCP antibodies with GIOP dose of GC, denosumab did not show a significant increase in lumbar spine and total hip T-scores and aBMD after 12 months compared to baseline. Furthermore, when compared to the group without GIOP dose of GC, the increase in T-score and aBMD at the total hip was significantly lower. <h3>Conclusion:</h3> Our results suggest that GIOP dose of GC attenuates the therapeutic efficacy of denosumab in increasing BMD in RA, particularly in the subgroup of patients negative for anti-CCP antibodies. <h3>REFERENCES:</h3> [1] Hu Q, Zhong X, Tian H and Liao P (2022) The Efficacy of Denosumab in Patients With Rheumatoid Arthritis: A Systematic Review and Pooled Analysis of Randomized or Matched Data. Front. Immunol. 12:799575. [2] Mayu Yagita et al., Therapeutic efficacy of denosumab for rheumatoid arthritis: a systematic review and meta-analysis, Rheumatology Advances in Practice 2021;00:1–12 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>