Most Read Articles
Roshini Claire Anthony, 17 Jul 2019

A combination of tocilizumab and methotrexate reduced disease activity at 2 years compared with methotrexate plus prednisone in patients with early rheumatoid arthritis (RA), an effect not demonstrated with tocilizumab monotherapy.

08 Jul 2017
Entecavir and lamivudine demonstrate comparable effects on the mortality rate of patients with chronic hepatitis B virus (HBV)-related acute exacerbation with or without acute-on-chronic liver failure (ACLF), reports a study. In patients with ACLF, however, entecavir delivers a more favourable long-term outcome and is associated with greater clinical improvements.
Pearl Toh, 26 Sep 2019
The Singapore Health Sciences Authority (HSA) has recalled eight brands of ranitidine products containing trace amounts of the nitrosamine impurity NDMA*, which is a potential human carcinogen.
05 Oct 2019
The combination of sofosbuvir and velpatasvir is safe and effective for the treatment of hepatitis C virus (HCV) in patients with end-stage renal disease (ESRD) undergoing haemodialysis, a study has shown.

Denosumab efficacy in GIOP not modified by prior antiosteoporotic therapy

Jairia Dela Cruz
25 Jun 2018

Denosumab yields increases in bone mineral density (BMD) in patients with glucocorticoid-induced osteoporosis (GIOP), and this benefit is not influenced by prior antiosteoporotic treatment, as shown in a study.

The study used real-world data and included 66 GIOP patients initiating denosumab, all of whom had been receiving several dosages of prednisolone (2–20 mg) for rheumatoid arthritis and connective tissue diseases. Prior to denosumab initiation, 23 patients had been treated with daily teriparatide and 27 with bisphosphonates. The remaining 16 were treatment naïve.

Mean BMD at the lumbar spine increased from baseline by 2.85 percent at 6 months (p<0.0001) and by 4.40 percent at 12 months (p<0.0001). More than half (68.2 percent) of the population exhibited gains >3 percent, whereas only few (16.67 percent) showed decline at 12 months. Furthermore, all bone turnover markers (NTX, BAP and P1NP) decreased at 6 months. [EULAR 2018, abstract THU0494]

Among patients with prior exposure to antiosteoporotic agents, transition to denosumab from bisphosphonates vs from teriparatide yielded a greater increase in BMD at 12 months (4.71 percent vs 3.71 percent). However, the difference in BMD changes between these two groups was not significant, not even when compared against that seen in the group of patients who did no transition or were treatment naïve.

Dosage or duration of prednisolone, body weight, and gender were significantly associated with a BMD increase of >3 percent at 12 months in a univariate logistic regression model. On further analysis, only prednisolone dose showed an independent association with clinical response to denosumab (odds ratio, 1.36; 95 percent CI, 1.045–1.761; p<0.01).

There were no reports of hypocalcaemia and osteonecrosis of the jaw ever occurring during the study period.

“Despite the good clinical efficacy of denosumab for primary osteoporosis, the 2017 American College of Rheumatology guideline for GIOP placed denosumab as second-line treatment because of lack of clinical experience with concomitant use of immunosuppressive agents,” the authors said.

The present data demonstrate that denosumab produces BMD gains in GIOP regardless of prior antiosteoporotic treatment, they added. In line with this, clinicians should consider denosumab in the treatment for GIOP, especially for patients exposed to higher glucocorticoid doses or at the time when the efficacy of bisphosphonates is diminished.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Pharmacist - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 17 Jul 2019

A combination of tocilizumab and methotrexate reduced disease activity at 2 years compared with methotrexate plus prednisone in patients with early rheumatoid arthritis (RA), an effect not demonstrated with tocilizumab monotherapy.

08 Jul 2017
Entecavir and lamivudine demonstrate comparable effects on the mortality rate of patients with chronic hepatitis B virus (HBV)-related acute exacerbation with or without acute-on-chronic liver failure (ACLF), reports a study. In patients with ACLF, however, entecavir delivers a more favourable long-term outcome and is associated with greater clinical improvements.
Pearl Toh, 26 Sep 2019
The Singapore Health Sciences Authority (HSA) has recalled eight brands of ranitidine products containing trace amounts of the nitrosamine impurity NDMA*, which is a potential human carcinogen.
05 Oct 2019
The combination of sofosbuvir and velpatasvir is safe and effective for the treatment of hepatitis C virus (HCV) in patients with end-stage renal disease (ESRD) undergoing haemodialysis, a study has shown.