Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study |
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| Institution: | 1. Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands;2. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands;3. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands;4. Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark;5. Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Copenhagen, Denmark;6. DANBIO – The Danish Rheumatologic Database, Copenhagen, Denmark;7. NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands;8. Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands;9. Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands;10. Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland;1. Division of Gastroenterology and Hepatology, UC Davis School of Medicine, Sacramento, Calif;2. Division of Clinical Informatics, UC Davis Medical Center, Sacramento, Calif;3. Division of Biostatistics, UC Davis Department of Public Health Sciences, Sacramento, Calif;4. Section of General Thoracic Surgery, UC Davis Medical Center, Sacramento, Calif;5. Division of Hematology and Oncology, UC Davis School of Medicine, Sacramento, Calif;1. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland;2. Department of Pediatrics, University Hospital Bern (Inselspital) Bern, Switzerland;3. Clinical Trials Unit (CTU), University of Bern, Bern, Switzerland;4. Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;5. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco;6. Department of Medicine, University of California San Francisco, San Francisco;7. Department of Cardiology, Kaiser Permanente Northern California, Oakland, Calif;8. Division of Research, Kaiser Permanente Northern California, Oakland, Calif;9. University General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland;1. Department of Internal Medicine I, Gastroenterology and Heptatology, Klinikum Wels-Grieskirchen, Wels, Austria;2. Institute of Nuclear Medicine, Klinikum Wels-Grieskirchen, Wels, Austria;3. Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria;4. Department of Internal Medicine IV, Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria;1. Department of General Medicine;2. Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan;1. Department of Dermatology and Venereal Disease, School of Tropical Medicine, Kolkata, West Bengal, India;2. Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India;3. Department of Dermatology and Venereal Disease, School of Tropical Medicine, Kolkata, West Bengal, India;4. Department of Pathology, ESI-PGIMSR, Maniktala, Kolkata, West Bengal, India |
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| Abstract: | ObjectivesClinical trials have shown a beneficial effect from biological disease-modifying antirheumatic drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis; however, it is unclear if this translates to a reduced fracture risk. We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in rheumatoid arthritis.MethodsA cohort of patients with rheumatoid arthritis aged 18+ from DANBIO was linked to population-based health registries in Denmark (2006-2016). Adopting a prevalent new-user design, we matched bDMARD users to bDMARD-naïve patients using time-conditional propensity scores. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, and forearm) was estimated among the matched patients by Cox proportional hazards models.ResultsOut of 24,678 patients with rheumatoid arthritis, 4265 bDMARD users were matched to the same number of bDMARD-naïve patients (mean age 56.2 years, 74% female). During follow-up, 229 osteoporotic fractures occurred among bDMARD users and 205 fractures among bDMARD-naïve patients (incidence rates 12.1 and 13.0 per 1000 person-years, respectively). The use of bDMARDs was not associated with a reduced risk of osteoporotic fractures among patients with rheumatoid arthritis (hazard ratio 0.97, 95% confidence interval 0.78-1.20), compared with no biological treatment. The risk estimates were similar for all osteoporotic fracture sites.ConclusionWe found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with rheumatoid arthritis. |
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