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More Bone Formation, Less Resorption With Infliximab for RA
NEW YORK (Reuters Health) Apr 11 - There is an improvement in the formation of bone and a reduction in bone resorption markers with the use of the anti-tumor necrosis factor-alpha (anti-TNF-alpha) drug infliximab in patients with rheumatoid arthritis (RA) whose disease has not responded to standard therapy.
The formation/resorption ratio "suggests beneficial systemic and local bone effects of infliximab in patients with RA," French investigators report in the March issue of the Annals of the Rheumatic Diseases.
RA is associated with systemic bone loss, subchondral bone erosion and cartilage degradation caused by pro-inflammatory cytokines, including tumour necrosis factor-alpha (TNF-alpha).
Dr. Thierry Thomas of the University Hospital of Saint-Etienne and colleagues administered the anti-TNF-alpha monoclonal antibody to 48 women who had severe RA for a mean of 11.4 years. Infliximab was started after failure of other disease-modifying antirheumatic drugs and investigators measured biochemical markers of bone turnover at baseline and after 6, 22 and 54 weeks.
Bone mineral density (BMD) remained stable over 1 year. Serum cathepsin K levels, a marker of cartilage degradation, rapidly decreased by 19% at week 6 and 28% at week 22. However, by week 54, the marker returned to pre-treatment levels.
In contrast, the marker for matrix metalloprotease levels progressively declined to a maximum of 25% decrease at week 54.
"In summary, the improvement in the formation/resorption marker ratio suggests beneficial systemic and local bone effects of infliximab in patients with RA," Dr. Thomas and colleagues note.
Studies are planned to determine if the biochemical changes translate to true positive structural effects on bone with infliximab therapy.
Ann Rheum Dis 2008;67:353-357.
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